24 530例妇女宫颈癌机会性筛查方法探讨

颜丽; 杨君; 周德平; 周晓军

doi:10.16016/j.1000-5404.201901041

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24 530例妇女宫颈癌机会性筛查方法探讨

临床医学 | 更新时间：2026-01-09

- 24 530例妇女宫颈癌机会性筛查方法探讨
- Opportunistic screening protocols for cervical carcinoma among different female populations in Chongqing
- 第三军医大学学报 2019年41卷第13期页码：1267-1274
- 作者机构：
  
  1.401147 重庆，重庆市妇幼保健院:宫颈病特色专科
  2.401147 重庆，重庆市妇幼保健院:保健部
- 作者简介：
  
  [杨君，E-mail：850495017@qq.comYANG Jun, E-mail: 850495017@qq.com
- 基金信息：
  
  重庆市卫计委重点基金项目(2013-1-043)
- DOI：10.16016/j.1000-5404.201901041
  中图分类号： R174.6;R730.4;R737.33
- 收稿：2019-01-06，
  
  修回：2019-03-29，
  
  纸质出版：2019-07-15
- 稿件说明：
移动端阅览
颜丽, 杨君, 周德平, 等. 24 530例妇女宫颈癌机会性筛查方法探讨[J]. 第三军医大学学报, 2019,41(13):1267-1274.

Li YAN, Jun YANG, Deping ZHOU, et al. Opportunistic screening protocols for cervical carcinoma among different female populations in Chongqing[J]. Journal of Third Military Medical University, 2019, 41(13): 1267-1274.
颜丽, 杨君, 周德平, 等. 24 530例妇女宫颈癌机会性筛查方法探讨[J]. 第三军医大学学报, 2019,41(13):1267-1274. DOI： 10.16016/j.1000-5404.201901041.

Li YAN, Jun YANG, Deping ZHOU, et al. Opportunistic screening protocols for cervical carcinoma among different female populations in Chongqing[J]. Journal of Third Military Medical University, 2019, 41(13): 1267-1274. DOI： 10.16016/j.1000-5404.201901041.

摘要

目的

评估5种宫颈癌筛查方案，探索适合不同临床特征人群的宫颈癌筛查模式。

方法

收集2013年1月至2015年12月重庆市13家妇幼保健院就诊并完成全部随访的妇女24 530人。根据其临床特征分为5组：A组(年轻女性组)、B组(哺乳期人群组)、C组(不孕症人群组)、D组(围绝经期及老年期女性人群组)、E组(育龄期普通人群组)，联合使用4种方法[醋酸肉眼观察法(visual inspection after acetic acid，VIA)，液基细胞学检查(thinprep cytologic test，TCT)，人乳头瘤病毒(human papillomavirus，HPV)-DNA检测，阴道镜检查]进行筛查，任一检查结果阳性即行宫颈活检送病理学检测，必要时行宫颈锥切术，其后每年随访1次，共随访2年。本研究以组织学诊断宫颈上皮内瘤变(cervical intraepithelial neoplasia，CIN)Ⅱ级及以上病变作为随访终点，分别计算不同筛查方案(单独采用VIA、TCT、HPV、阴道镜及联合采用TCT+HPV)诊断CINⅡ+的灵敏度、特异度、阳性预测值、阴性预测值、约登指数及曲线下面积(area under curve，AUC)，以AUC评价不同检测方法诊断的准确性。

结果

① A组中，5种筛查方案的AUC之间差异无统计学意义(

0.005)。②B组中，HPV及联合方案的AUC大于其他3种筛查方案，差异有统计学意义(

0.005)；③C组中，联合方案的AUC大于其他4种筛查方案，差异有统计学意义(

0.005)；④D组中，TCT、HPV及联合方案的AUC大于其他2种筛查方案，差异有统计学意义(

0.005)；⑤E组中，HPV的AUC大于其他4种筛查方案，差异有统计学意义(

0.005)。

结论

不同临床特征人群采取的宫颈癌筛查方案不尽相同，采取适宜的筛查方案可提高检出率。

Abstract

Objective

To evaluate the 5 protocols of opportunistic screening for cervical carcinoma among different female populations

in order to explore optional protocol for the women with different clinical characteristics.

Methods

A total of 24 530 women who admitted in 13 maternal and child health hospitals from January 2013 to December 2015 and completed our follow-up were recruited in this study. According to their clinical characteristics

they were divided into 5 groups: group A (young females

21~24 years old)

group B (lactating women)

group C (with identified infertility

25~39 years old)

group D (perimenopausal and elderly women)

group E (women of childbearing age

25~39 years old). Five protocols were used for opportunistic screening

that is

visual inspection after acetic acid (VIA)

thinprep cytologic test (TCT)

human papillomavirus (HPV)-DNA test

colposcopy

and combination of TCT and HPV-DNA test. All the suspected cases (at least 1 positive result) underwent biopsy

and/or cervical conization when necessary. All the cases were followed up once a year

for 2 years. Histological diagnosis of cervical intraepithelial neoplasia (CIN) grade Ⅱ and above lesions was regarded as the follow-up endpoints. The sensitivity

specificity

positive predictive value

negative predictive value

Youden's index and area under curve (AUC) of CIN Ⅱ+ were calculated for different screening schemes (VIA

TCT

HPV

colposcopy and TCT+HPV) in order to evaluate the diagnostic accuracy of these protocols.

Results

① In group A

there was no significant difference in AUC among the 5 protocols (

0.005). ② In group B

the AUCs of HPV and TCT+HPV were significantly greater than those of the other protocols (

0.005). ③In group C

the AUC of the combined screening was greater than those of the other ones

with statistical differences (

0.005). ④In group D

the AUCs of TCT

HPV

and the combined screening were significantly greater than those of the other ones (

0.005). ⑤ In group E

the AUC of HPV was si

gnificantly greater than those of the other ones (

0.005).

Conclusion

Different opportunistic screening protocols for cervical carcinoma are suitable for the women with different clinical characteristics. Optional screening protocols can improve the detection rate.

关键词

Keywords

references

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