宫颈癌筛查人群中的高危型人乳头状瘤病毒阴性宫颈病变  

High-risk human papillomavirus negative cervical lesions in the cervical cancer screening population

作　　者：赵静[1] 蔡晶 孙思[1] 黄在菊 王泽华[1] 吴莉英 Zhao Jing;Cai Jing;Sun Si;Huang Zaiju;Wang Zehua;Wu Liying(Department of Obstetrics and Gynecology,Union Hospital,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院妇产科,武汉430022

出　　处：《中国医师杂志》2023年第5期656-660,共5页Journal of Chinese Physician

摘　　要：目的研究筛查人群中高危人乳头状瘤病毒(hrHPV)阴性宫颈病变的发生率,并基于此初步评估HPV初筛相对于联合筛查可能的伤害(漏诊)和获益(减少阴道镜转诊),为宫颈癌初筛方式的选择提供参考。方法本研究为单中心横断面研究。纳入2018年1月1日至2019年12月31日于华中科技大学同济医学院附属协和医院行联合筛查[hrHPV分型检测加宫颈液基细胞学检查(LCT)]的宫颈癌筛查女性,分析该人群中hrHPV阴性的细胞学异常及宫颈病变所占比例,并计算联合筛查和HPV初筛方案的理论阴道镜转诊率。在有宫颈病理结果的人群中计算两种筛查方案诊断一例宫颈上皮内瘤变2级及以上病变(CIN2+)所需的阴道镜检人次数。结果共纳入35321例筛查女性。人群总体hrHPV感染、LCT异常与LCT重度异常的发生率分别为17.13%(6051/35321)、18.07%(6384/35321)与3.97%(1402/35321)。宫颈细胞学重度异常女性中hrHPV阴性率高达51.28%(719/1402),宫颈活检诊断的CIN2+病变中hrHPV阴性者占7.15%(49/685)。联合筛查和HPV初筛的理论阴道镜转诊率分别为11.28%(3985/35321)和8.33%(2943/35321),平均诊断一例CIN2+分别需要3.51和2.81人次阴道镜检。结论在机会性筛查人群中,hrHPV阴性CIN2+病变比例不容忽视,而HPV初筛策略可能造成这些病变的漏诊,但相对于联合筛查,HPV初筛有提高阴道镜检效率的潜能。这些结果提示我们应该谨慎选择HPV初筛方案。Objective To investigate the incidence of high-risk human papillomavirus(hrHPV)negative cervical lesions in the screening population,and based on this,to preliminarily evaluate the potential harm(missed diagnosis)and benefits(reduced colposcopy referral)of HPV primary screening compared to combined screening so as to provide reference for the selection of cervical cancer primary screening methods.Methods This study was a single center cross-sectional study.Women who underwent joint screening[hrHPV typing test combined with cervical liquid based cytology test(LCT)]at the Union Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from January 1,2018 to December 31,2019 were included in the cervical cancer screening.The proportion of hrHPV negative cytological abnormalities and cervical lesions in the population was analyzed and the theoretical colposcopy referral rate of the combined screening and HPV initial screening protocol was calculated.In the population with cervical pathological results,the number of colposcopy examinations required for the diagnosis of cervical intraepithelial neoplasia grade 2 and above(CIN2+)was calculated.Results A total of 35321 screened women were included.The overall incidence of hrHPV infection,LCT abnormalities and severe LCT abnormalities in the population was 17.13%(6051/35321),18.07%(6384/35321),and 3.97%(1402/35321),respectively.The negative rate of hrHPV in women with severe cervical cytology abnormalities was as high as 51.28%(719/1402),and in CIN2+lesions diagnosed by cervical biopsy,hrHPV negative accounted for 7.15%(49/685).The theoretical colposcopy referral rates for combined screening and initial HPV screening were 11.28%(3985/35321)and 8.33%(2943/35321),respectively,with an average diagnosis of CIN2+requiring 3.51 and 2.81 colposcopy examinations,respectively.Conclusions In the opportunistic screening population,the proportion of hrHPV negative CIN2+lesions cannot be ignored,and the HPV initial screening strategy may cause missed

关 键 词：宫颈肿瘤 癌症筛查 人乳头状瘤病毒DNA检测 液基薄层细胞学检查 

分 类 号：R737.33[医药卫生—肿瘤]