舟山市2015年至2018年宫颈癌筛查结果及不同初筛方法研究

Analysis of the cervical cancer screening results and different primary screening methods in Zhoushan from 2015 to 2018

目的分析舟山市宫颈癌筛查结果,比较液基薄层细胞学检查(TCT)和人乳头瘤病毒(HPV)检查作为初筛方法在宫颈癌筛查中的应用效果。方法汇总2015年至2018年舟山市宫颈癌项目季报表数据,采用χ^(2)检验比较宫颈病变检出情况及不同初筛方法的效果。结果①共有74758人次接受了宫颈癌初筛,良性病变中细菌性阴道病检出率高(11.84%),转诊组织病理检查异常率达54.70%,检出低级别病变、高级别病变、宫颈癌依次为34.51%、18.08%、2.11%。②2015年至2018年初筛阳性率、TCT阳性率、低级别病变、高级别病变、癌前病变、宫颈癌检出率呈逐年升高趋势(P<0.05),其中宫颈癌平均检出率为65.54/10万,其中2016年最低(22.68/10万),2018年最高(98.34/10万)。③采用HPV初筛检出低级别病变、高级别病变、癌前病变、宫颈癌的检出率明显高于TCT初筛,尤其是HPV初筛对宫颈癌的检出率(79.74/10万)明显高于TCT初筛(34.27/10万)(P<0.05)。④不同初筛方式的阳性检出率比较差异有统计学意义,HPV初筛对宫颈病变的筛查效果更佳。结论舟山市采用的宫颈癌筛查方案中HPV初筛优于TCT初筛,筛查的有效性有明显提升,证实了现在舟山市采取HPV初筛的适用性。舟山市近年来宫颈癌检出率显著增高且呈逐年上升的趋势,需加大宫颈癌筛查力度和健康干预,以进一步降低宫颈癌的发病及病死率。

Objective To analyze the results of cervical cancer screening programme in Zhoushan,and compare the application effect of thin-prep cytology test(TCT)and human papilloma virus(HPV)as primary screening methods in cervical cancer screening.Methods Date were collected from the quarterly report of the cervical cancer screening programme in Zhoushan from 2015 to 2018.χ^(2) tests were used to examine the detection rate of cervical diseases and different initial methods.Results①A total of 74758 women received the initial screening of cervical cancer.The detection rate of bacterial vaginosis was high(11.84%).The positive rate of histopathology was 54.70%.The detection rate of low grade lesions,high grade lesions and cervical cancer were 34.51%,18.08%and 2.11%respectively.②The initial screening positive rate,TCT positive rate,low-grade lesions,high-grade lesions,precancerous lesions and cervical cancer detection rate increased year by year(P<0.05).The average detection rate of cervical cancer was 65.54/100000,which was the lowest in 2016(22.68/100000)and the highest in 2018(98.34/100000).③The detection rate of low-grade lesions,high-grade lesions,precancerous lesions and cervical cancer by HPV screening was significantly higher than that by TCT screening,especially the detection rate of cervical cancer by HPV screening(79.94/100000)was significantly higher than that by TCT screening(34.27/100000)(P<0.05).④The positive detection rate of different screening methods was statistically significant.HPV screening was better.Conclusions HPV primary screening is better than TCT primary screening,which confirms the applicability of HPV primary screening in Zhoushan.In recent years,the detection rate of cervical cancer has increased significantly.It is necessary to strengthen the screening of cervical cancer and health intervention to further reduce the incidence and mortality of cervical cancer.