Effectiveness of Co-Testing in Cervical Cancer Screening Program in Macao SAR

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.

一种基底细胞概略检测方法

根据宫颈细胞病理学及2001TBS诊断系统,在液基宫颈癌细胞自动筛查过程中,基底细胞过多是一种病理异常现象,需要提示人工阅片.针对这点,提出一种快速识别异常标本的概略检测方法.该方法根据计算机多尺度视觉不变性,采用视觉尺度缩小方式,提高了计算速率,同时利用从北京协和检验洛奇临床检验所采集来的大量标本进行实验验证.结果表明:该方法速度快、计算量小、可靠性高,在工程应用中是可行的.

泰安市宫颈癌筛查情况分析

目的对泰安市宫颈癌筛查情况进行分析，为探讨适宜宫颈癌的筛查模式提供参考。方法2010年10月对泰安市岱岳区所辖乡镇6830名已婚妇女开展宫颈癌筛查。采用专用宫颈刷收集宫颈及颈管脱落细胞，放入盛有专用保存液的标本瓶中，制成薄层细胞涂片，进行FeulgenDNA染色做DNA定量测定，由全自动DNA倍体定量分析系统进行扫描。用DNA指数（DNAindex，DI）代表细胞核的DNA含量，DI〉2．5为异常细胞，异常细胞称为异倍体细胞。如检查未见异倍体细胞，建议按常规定期筛查；见1-2个异倍体细胞或细胞增殖比例5％-10％，建议4-6个月复查；≥3个异倍体细胞或者细胞增殖比例），10％，均建议行阴道镜检查、宫颈组织活检。组织学病理诊断包括：（1）正常或炎症；（2）宫颈上皮内瘤变（cervicMintraepitheliMneoplasia，CIN）：分为CINI、CINⅡ、CINⅢ及原位癌；（3）浸润癌。数据输入Excel2003，进行描述性分析。结果6830名已婚妇女中异倍体细胞检出率8．39％，1-2个检出率5．81％，≥3个检出率2．58％。阴道镜下活检，CINⅡ及以上病变51例，患病率为0．75％。原位癌患病率为0．04％，浸润癌患病率为0．03％。30~45岁CIN和宫颈癌高发，其中30。35岁、35～40岁、40～45岁CINI、CINⅡ、CINm、原位癌、浸润癌患病率分别为1．84％、0．70％、0．61％、0．09％、0．09％．1．23％、0．65％、0．39％、0．06％、0，0．82％、0．16％、0．25％、0．08％、0。结论全自动DNA倍体定量分析系统可以作为宫颈癌可靠方法，同时加强宣传、提高筛查覆盖率、规范宫颈病变的早诊早治技术，可降低宫颈癌的患病率和病死率。