Int J Cancer:细胞学检查中加入高危HPV检测,可更早地发现宫颈侵袭前病变

2021-04-18 MedSci原创 MedSci原创

高危HPV感染是宫颈癌发生的主要病因。横断面研究表明,高危HPV感染的检测在检测高位宫颈上皮内瘤变(CIN)方面比细胞学检查敏感度高约23-43%,但特异性明显降低。根据现有的研究证据,许多西方国家已

高危HPV感染是宫颈癌发生的主要病因。横断面研究表明,高危HPV感染的检测在检测高位宫颈上皮内瘤变(CIN)方面比细胞学检查敏感度高约23-43%,但特异性明显降低。根据现有的研究证据,许多西方国家已经发布了将HPV检测纳入其宫颈筛查计划的国家指南。然而,亚洲地区宫颈筛查策略仍然存在很大的差异,对HPV检测没有明确的指导。在亚洲人群中进行的大型RCT将有助于在这个地区制定适当的筛查指南。

 

近日,研究人员进行了一项前瞻性随机对照试验,进行了两轮筛查,以评估HPV检测与体液细胞学(LBC)联合检测与仅LBC在中国人群宫颈癌筛查中的效果,研究结果已发表于Int J Cancer。

研究纳入了15,955名30-60岁的女性,随机分为干预组(HPV与LBC检测)和对照组(LBC检测)。干预组女性无论细胞学检查结果如何,如果发现为高危HPV,立即转诊进行阴道镜检查和活检。

 

结果显示,与对照组相比,干预组宫颈上皮内瘤变2级或以上(CIN2+)病变的检出率明显高于对照组(0.95% vs. 0.38%,OR 2.50,95% CI 1.65-3.88)。在约36个月后的下一轮筛查中,干预组的CIN2+检出率显著降低(0.08% vs 0.35%,OR 0.23,95% CI 0.08-0.57)。在两轮筛查中,干预组CIN2+的总检出率更高(1.01% vs 0.66%,OR 1.53,95% CI 1.09-2.19)。干预组进行的阴道镜检查次数增加了4倍(10.6% vs 2.4%,p <0.001)。

综上所述,该研究结果表明,在宫颈初筛的细胞学检查中加入高危HPV检测,可更早地发现有临床意义的侵袭前病变,从而降低了后续几轮CIN2+病变的检出率,提高了阴道镜检查率。

 

原始出处:

 

Karen K L Chan, et al., Primary HPV testing with cytology versus cytology alone in cervical screening-A prospective randomized controlled trial with two rounds of screening in a Chinese populatio. Int J Cancer. 2020 Aug 15;147(4):1152-1162. doi: 10.1002/ijc.32861.  

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    2021-04-22 科研科研科研

    细胞学检查加入HPV检测

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    2021-04-20 一闲
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    2021-04-18 医鸣惊人

    认真学习了

    0

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