农村地区以人群为基础的子宫颈癌筛查中HPV初筛不同分流方法效果的初步评价
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摘要
目的评价农村地区妇女以高危人乳头瘤病毒(high risk human papillomavirus,HPV)检测为初筛的宫颈癌筛查中不同分流方式的效果,探索适合中国农村地区成本效益的HPV初筛阳性后的分流方案。方法2014年10月至2016年1月在7个农村现场进行了以人群为基础的HPV检测宫颈癌筛查,HPV初筛阳性者分别采用液基细胞学(LBC)、巴氏涂片、HPV16/18分型,HPV载量(VL)或醋酸/碘染色肉眼观察检查(VIA/VILI)作为分流方法。以最终的病理学诊断结果为金标准评价5种分流方法的效果。结果筛查数据完整并纳入研究共17 782例,HPV感染率13.56%(2 412/17 782)。5种分流方式中HPV16/18分型和HPV载量的灵敏度(86.8%和72.1%)和特异度(85.8%和71.4%)较高,ROC工作曲线(0.863和0.717)优于其他3种分流方式,获得最终病理确诊平均时间较短(平均9.2 d和9.2 d)(P <0.05)。结论在农村地区HPV为初筛后采用HPV16/18和HPV载量分流方式因其灵敏度、特异度较好,仅需一次召回,获得病理诊断时间短等优势,是目前较适宜的分流方案。
Objective To evaluate the optimal triages of HPV primary screening in rural areas, and to explore the cost-effectiveness triage method after positive initial screening of HPV in rural areas of china. Methods A population-based cervical cancer screening for cervical cancer was carried out at seven rural sites between October 2014 and January 2016. The positive women of HPV primary screening was triaged by liquid based cytology(LBC), Pap Smear, HPV16/18 test, HPV load(VL) and visual inspection with acetic acid and lugol's iodine(VIA/VILI) respectively. The results of the five methods were evaluated using the gold standard of the final pathological diagnosis. Results 17,782 case with complete data were included in the study, HPV infection rate was 13.56%(2412/17782). The sensitivity(86.8% and 72.1%) and specificity(85.8% and 71.4%) of HPV16/18 typing and HPV load were higher and of which, ROC(0.863 and 0.717) and the pathologic diagnosis time(9.2 d and 9.2 d) were better than others(P < 0.05). Conclusions Concerned about present situation and adaptability of cytological diagnosis in rural areas of china, triage with HPV16/18 or HPV load for hrHPV-positive women appear to be the most feasible management strategies in rural areas in China.
Objective To evaluate the optimal triages of HPV primary screening in rural areas, and to explore the cost-effectiveness triage method after positive initial screening of HPV in rural areas of china. Methods A population-based cervical cancer screening for cervical cancer was carried out at seven rural sites between October 2014 and January 2016. The positive women of HPV primary screening was triaged by liquid based cytology(LBC), Pap Smear, HPV16/18 test, HPV load(VL) and visual inspection with acetic acid and lugol's iodine(VIA/VILI) respectively. The results of the five methods were evaluated using the gold standard of the final pathological diagnosis. Results 17,782 case with complete data were included in the study, HPV infection rate was 13.56%(2412/17782). The sensitivity(86.8% and 72.1%) and specificity(85.8% and 71.4%) of HPV16/18 typing and HPV load were higher and of which, ROC(0.863 and 0.717) and the pathologic diagnosis time(9.2 d and 9.2 d) were better than others(P < 0.05). Conclusions Concerned about present situation and adaptability of cytological diagnosis in rural areas of china, triage with HPV16/18 or HPV load for hrHPV-positive women appear to be the most feasible management strategies in rural areas in China.
引文
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[13]李凌,李隆玉,杨起楠,等.高危型HPV载量与分型检测对宫颈高级别病变价值预测的前瞻性队列研究[J].中国肿瘤临床,2016,43(9):376-380.
[14]李雨聪.高危型人乳头瘤病毒检测初筛宫颈癌后几种分流方法的对比研究[D].重庆医科大学,2015.
[2]Ronco G,Zappa M,Franceschi S,et al.Italian HPV Survey Working Group.Impact of variations in triage cytology interpretation on human papillomavirus-based cervical screening and implications for screening algorithms[J].Eur J Cancer,2016,68(11):148-155.
[3]Schiffman M,Hyun N,Raine-Bennett TR,et al.A cohort study of cervical screening using partial HPV typing and cytology triage[J].Int J Cancer,2016,139(11):2606-2615.
[4]Wentzensen N,Schiffman M,Palmer T,et al.Triage of HPVpositive women in cervical cancer screening[J].J Clin Virol,2016,76(Suppl 1):S49-S55.
[5]Huh WK,Ault KA,Chelmow D,et al.Use of primary high-risk human papillomavirus testing for cervical cancer screening:interim clinical guidance[J].Gynecol Oncol,2015,136(2):178-182.
[6]World Health Organization.Comprehensive cervical cancer control:A guide to essential practice[M].2nd ed.Geneva:World Health Organization,2014:123-136.
[7]Liu B,Taioli E.Associations between human papillomavirus and history of cancer among U.S.adults in the National Health and Nutrition Examination Survey(2003-2010)[J].Br J Cancer,2014,111(7):1448-1453.
[8]Louvanto K,Chevariedavis M,Ramanakumar,et al.HPV testing with cytology triage for cervical cancer screening in routine practice.Am J Obstet Gynecol,2014,210(5):474.e1-474.e7.
[9]Beal CM,Salmern J,Flores YN,et al.Cost analysis of different cervical cancer screening strategies in Mexico[J].Salud Publica Mex,2014,56(5):429-501.
[10]党乐,马俊飞,郭董平,等.我国农村地区宫颈癌筛查中人乳头瘤病毒检测阳性女性的分流策略[J].中国肿瘤临床与康复,2017,24(3):257-264.
[11]Muwonge R,Wesley RS,Nene BM,et al.Evaluation of cytology and visual triage of human papillomavirus-positive women in cervical cancer prevention in India[J].Int J Cancer,2014,134(12):2902-2909.
[12]Wang M,Hu S,Zhao S,et al.Accuracy of triage strategies for human papillomavirus DNA-positive women in low-resource settings:A cross-sectional study in China[J].Chin J Cancer Res,2017,29(6):496-509.
[13]李凌,李隆玉,杨起楠,等.高危型HPV载量与分型检测对宫颈高级别病变价值预测的前瞻性队列研究[J].中国肿瘤临床,2016,43(9):376-380.
[14]李雨聪.高危型人乳头瘤病毒检测初筛宫颈癌后几种分流方法的对比研究[D].重庆医科大学,2015.