Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introdu...Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.展开更多
目的液基细胞学检查系统(liquid based cytology test,LCT)已成功而广泛地应用于宫颈细胞学诊断,而用于支气管刷片细胞学诊断国内外报道均很少。本研究试图探讨LCT在肺癌患者支气管刷检检查中的应用价值。方法选取712例同时进行了刷检...目的液基细胞学检查系统(liquid based cytology test,LCT)已成功而广泛地应用于宫颈细胞学诊断,而用于支气管刷片细胞学诊断国内外报道均很少。本研究试图探讨LCT在肺癌患者支气管刷检检查中的应用价值。方法选取712例同时进行了刷检传统涂片细胞学检查,刷检液基细胞学检查和组织学(活检和/或手术)检查,计算涂片和LCT的敏感度、特异度及分型的符合率。结果LCT和传统涂片法诊断肺癌敏感度分别为70.55%和61.15%;两者的特异度分别为85.65%和87%;刷检液基细胞学对常见肺癌分型的符合率均较传统涂片高,特别是对腺癌诊断的符合率,液基细胞学(82.0%)明显优于传统涂片(64.8%)(χ2=7.419,P=0.006)。分型符合的一致性检验的Kappa值分别为0.970和0.960。结论LCT是在支气管刷检制片、染色等方面便于实施质量控制的一项新技术,是一种诊断肺癌的可靠方法,敏感度高,对组织学分型亦有较高的参考价值。展开更多
文摘Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.
文摘目的液基细胞学检查系统(liquid based cytology test,LCT)已成功而广泛地应用于宫颈细胞学诊断,而用于支气管刷片细胞学诊断国内外报道均很少。本研究试图探讨LCT在肺癌患者支气管刷检检查中的应用价值。方法选取712例同时进行了刷检传统涂片细胞学检查,刷检液基细胞学检查和组织学(活检和/或手术)检查,计算涂片和LCT的敏感度、特异度及分型的符合率。结果LCT和传统涂片法诊断肺癌敏感度分别为70.55%和61.15%;两者的特异度分别为85.65%和87%;刷检液基细胞学对常见肺癌分型的符合率均较传统涂片高,特别是对腺癌诊断的符合率,液基细胞学(82.0%)明显优于传统涂片(64.8%)(χ2=7.419,P=0.006)。分型符合的一致性检验的Kappa值分别为0.970和0.960。结论LCT是在支气管刷检制片、染色等方面便于实施质量控制的一项新技术,是一种诊断肺癌的可靠方法,敏感度高,对组织学分型亦有较高的参考价值。
