24530例妇女宫颈癌机会性筛查方法探讨

Opportunistic screening protocols for cervical carcinoma among different female populations in Chongqing

目的评估5种宫颈癌筛查方案,探索适合不同临床特征人群的宫颈癌筛查模式。方法收集2013年1月至2015年12月重庆市13家妇幼保健院就诊并完成全部随访的妇女24 530人。根据其临床特征分为5组:A组(年轻女性组)、B组(哺乳期人群组)、C组(不孕症人群组)、D组(围绝经期及老年期女性人群组)、E组(育龄期普通人群组),联合使用4种方法[醋酸肉眼观察法(visual inspection after acetic acid,VIA),液基细胞学检查(thinprep cytologic test,TCT),人乳头瘤病毒(human papillomavirus,HPV)-DNA检测,阴道镜检查]进行筛查,任一检查结果阳性即行宫颈活检送病理学检测,必要时行宫颈锥切术,其后每年随访1次,共随访2年。本研究以组织学诊断宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅱ级及以上病变作为随访终点,分别计算不同筛查方案(单独采用VIA、TCT、HPV、阴道镜及联合采用TCT+HPV)诊断CINⅡ+的灵敏度、特异度、阳性预测值、阴性预测值、约登指数及曲线下面积(area under curve, AUC),以AUC评价不同检测方法诊断的准确性。结果①A组中,5种筛查方案的AUC之间差异无统计学意义(P>0.005)。②B组中,HPV及联合方案的AUC大于其他3种筛查方案,差异有统计学意义(P<0.005);③C组中,联合方案的AUC大于其他4种筛查方案,差异有统计学意义(P<0.005);④D组中,TCT、HPV及联合方案的AUC大于其他2种筛查方案,差异有统计学意义(P<0.005);⑤E组中,HPV的AUC大于其他4种筛查方案,差异有统计学意义(P<0.005)。结论不同临床特征人群采取的宫颈癌筛查方案不尽相同,采取适宜的筛查方案可提高检出率。

Objective To evaluate the 5 protocols of opportunistic screening for cervical carcinoma among different female populations,in order to explore optional protocol for the women with different clinical characteristics.Methods A total of 24 530 women who admitted in 13 maternal and child health hospitals from January 2013 to December 2015 and completed our follow-up were recruited in this study.According to their clinical characteristics,they were divided into 5 groups:group A(young females,21~24 years old),group B(lactating women),group C(with identified infertility,25~39 years old),group D(perimenopausal and elderly women),group E(women of childbearing age,25~39 years old).Five protocols were used for opportunistic screening,that is,visual inspection after acetic acid(VIA),thinprep cytologic test(TCT),human papillomavirus(HPV)-DNA test,colposcopy,and combination of TCT and HPV-DNA test.All the suspected cases(at least 1 positive result)underwent biopsy,and/or cervical conization when necessary.All the cases were followed up once a year,for 2 years.Histological diagnosis of cervical intraepithelial neoplasia(CIN)gradeⅡand above lesions was regarded as the follow-up endpoints.The sensitivity,specificity,positive predictive value,negative predictive value,Youden’s index and area under curve(AUC)of CINⅡ+were calculated for different screening schemes(VIA,TCT,HPV,colposcopy and TCT+HPV)in order to evaluate the diagnostic accuracy of these protocols.Results①In group A,there was no significant difference in AUC among the 5 protocols(P>0.005).②In group B,the AUCs of HPV and TCT+HPV were significantly greater than those of the other protocols(P<0.005).③In group C,the AUC of the combined screening was greater than those of the other ones,with statistical differences(P<0.005).④In group D,the AUCs of TCT,HPV,and the combined screening were significantly greater than those of the other ones(P<0.005).⑤In group E,the AUC of HPV was significantly greater than those of the other ones(P<0.005).Conclusion Different opportunistic screening protocols for cervical carcinoma are suitable for the women with different clinical characteristics.Optional screening protocols can improve the detection rate.