浙江省淳安县居民宫颈癌筛查3034例分析

Analysis of the results of 3034 cases of cervical cancer screening in Chun'an county

目的了解浙江省淳安县居民的宫颈癌筛查情况,为该病的防控提供流行病学资料。方法采用分层抽样调查方法,整个筛查分2次(2015年6月至2016年1月为第1次,2017年9月至2018年2月为第2次)共32个月完成,采用多阶段抽样的方法完成筛查,第1次(2015年6月至2016年1月)从淳安县23个乡镇中随机抽取6个乡镇的农村户籍妇女,之后采取整群抽样法对6个乡镇内符合年龄要求的妇女全部进行筛查。2015年6月至2016年1月在淳安县选取30~65岁的健康妇女3034例为研究对象,进行宫颈癌筛查,所有受调查者分为未分型人乳头瘤状病毒(HPV)初筛组(2018例)及醋酸和卢戈氏碘液染色肉眼观察初筛组(VIA/VILI)组(1016例),两组HPV阳性者再进行阴道镜检查,对镜下异常者行组织病理学检测。2017年9月至2018年2月对原筛查人群进行第2次筛查,流程同第1次。统计分析初筛HPV阳性率、宫颈鳞状上皮内瘤样病变Ⅱ级及以上(CINⅡ+)病变检出率。结果2015年6月至2016年1月筛查结果:未分型HPV初筛组阳性率为11.60%(234/2018),行阴道镜检查150例(64.10%,150/234),其中阳性119例(79.33%);行VIA/VILI检查阳性31例(20.66%,31/150)。VIA/VILI初筛组阳性率为20.28%(206/1016),行阴道镜检查205例(99.51%)。两组共行阴道镜检查355例,其中对108例可疑病例行病理活检,病理活检率30.42%(108/355),病理活检结果:CINⅡ+9例(9/3034)。2017年9月至2018年2月第2次筛查召回原筛查者共计2363例,召回率77.89%(2363/3034),两组筛查阳性402例(17.01%),阴道镜检查322例(80.10%,322/402),病理活检80例(24.84%,80/322),病理结果显示CINⅡ+检出率为296/10万(7/2363)。结论淳安县居民的宫颈癌筛查癌前病变检出率低于全国平均水平,但应加强主动筛查宣教力度,提高筛查对象的依从性和配合度,提高可疑病例召回率;同时提高基层筛查点医生的筛查技术,提高宫颈癌前病变的检出率。

Objective To understand the screening of cervical cancer in our county and provide epidemiological data for the prevention and control of cervical cancer.Methods A total of 3034 healthy women with 30~65 years old in Chun'an county were recruited in this prospective study from June 2015 to January 2016.All of the subjects received cervical cancer screening.The respondents were randomly divided into non-typeable HPV screening group(2018 cases)and the vision inspection with acetic acid and visual inspection with Lugol's iodine screen(VIA/VILI)group(1016 cases).Direct colposcopy or VIA/VILI visual examination was performed for those with positive HPV,and then colposcopy was performed for those with positive visual examination.The suspicious lesions tissues were applied for pathology detection.From September 2017 to February 2018,2363 patients who were initially negative received VIA/VILI combined with unclassified HPV examination,and those who were positive received colposcopy and pathological biopsy.The positive rate of primary screening and cervical squamous intraepithelial neoplasia disorders level 2 and above(CINⅡ+)lesion detection rate were analyzed in the two-stage screening.Results From June 2015 to January 2016,the preliminary screening positive rate of unclassified HPV group was 11.60%(234/2018).A total of 150 patients with positive results were recalled for colposcopy,with a recall rate of 64.10%(150/234).Among the 150 cases,119 cases(79.33%)were positive in the unclassified HPV preliminary screening,and 31 cases(20.66%)were positive in VIA/VILI examination after HPV preliminary screening.The positive rate of VIA/VILI initial screening group was 20.28%(206/1016),and the recall rate of colposcopy was 99.51%(205/206).A total of 108 cases underwent colposcopy with abnormal pathological biopsy examination in the two groups,and the pathological biopsy rate was 30.34%(108/356),and the pathologic biopsy CINⅡ+lesion detection rate was 297/100000(9/3034).In the second round of screening from September 2017 to February 2018,2363 subjects were recruited back to the baseline,with a recall rate of 77.89%(2363/3034).In the 2363 cases,the early screen VIA/VILI anomalies or HPV positive early screening positive rate was 17.01%(402/2363),and the colposcopy examination the recall rate was 80.10%(322/402),and 80 cases received vaginal lens suspicious pathological biopsy,the pathological biopsy rate was 24.84%(80/322),the pathological results showed that CINⅡ+detection rate of 296/100000(7/2363).Conclusion The detection rate of precancerous suspicious lesions in cervical cancer screening in our county is lower than the national average level.On the one hand,we should strengthen the propaganda and education of active screening,improve the compliance and cooperation degree of screening objects,and improve the recall rate of suspicious cases.On the other hand,the government should invest more efforts to select the screening technology with high sensitivity,improve the screening technology of doctors at the basic screening point,and improve the detection rate of cervical cancer prelesions.