中国子宫颈癌筛查指南(二)  

Guidelines for cervical cancer screening in China Ⅱ

作　　者：中国优生科学协会阴道镜和宫颈病理学分会 中华医学会妇科肿瘤学分会 中国抗癌协会宫颈癌专业委员会 中国医疗保健国际交流促进会妇产健康医学分会 中国癌症基金会全国宫颈癌防治协作组 中华预防医学会肿瘤预防与控制专业委员会 中国妇幼健康研究会宫颈癌防控研究专业委员会 隋龙[2] 孔北华[3] 李明珠[4] 李静然[4] 李晓[5] 王新宇 孔令华[7] 陈飞[7] 丛青[2] 吴鹏[8] 黄晓园 赵方辉[10] 王临虹[11] 张瑜 孙蓬明[13] 马丁[9] 魏丽惠[4] Chinese Society for Colposcopy and Cervical Pathology of China Healthy Birth Science Association;Chinese Society of Gynecological Oncology,Chinese Medical Association;Chinese Cervical Cancer Society;Branch of Women's Health Medicine of China International Exchange and Promotive Association for Medical and HeaIth Care;National Cervical Cancer Prevention Consortium of Cancer Foundation of China;Branch of Cancer Prevention and Control,Chinese Preventive Medicine Association;Chinese Association for Maternal and Child Health Studies

机构地区：[1]不详 [2]复旦大学附属妇产科医院 [3]山东大学齐鲁医院 [4]北京大学人民医院 [5]浙江大学医学院附属妇产科医院 [6]浙江大学医学院附属第一医院 [7]北京协和医院 [8]华中科技大学同济医学院附属协和医院 [9]华中科技大学同济医学院附属同济医院 [10]中国医学科学院肿瘤医院 [11]中国疾病预防控制中心 [12]中南大学湘雅医院 [13]福建省妇幼保健院

出　　处：《现代妇产科进展》2025年第1期1-9,共9页Progress in Obstetrics and Gynecology

基　　金：国家重点研发计划(2021YFC2701202,2021YFC2701203,2021YFC2701204)。

摘　　要：结合我国子宫颈癌前病变和子宫颈癌发病情况以及全球子宫颈癌筛查策略,为实现消除子宫颈癌的目标,我国七个学(协)会专家共同制定了子宫颈癌筛查指南(二)。本指南重点在于规范子宫颈癌筛查结果异常的分流方法,其目的是通过精细化管理,避免过度诊断与漏诊。高危型人乳头瘤病毒(high-risk human papillomavirus, HR-HPV)检测初筛阳性人群以子宫颈细胞学检查为主要分流方法;子宫颈细胞学初筛阳性人群以其结果的不同风险进行管理。此外,p16/Ki-67双重染色用于HR-HPV初筛不分型检测阳性或非HPV16/18的其他12种HR-HPV检测(简称12 HR-HPV)阳性的分流,也可用于联合筛查中HR-HPV不分型检测阳性或12 HR-HPV阳性,同时细胞学检查为未见上皮内病变或恶性细胞(negative for intraepithelial lesion or malignancy, NILM);未明确诊断意义的不典型鳞状细胞(atypical squamous cells of undetermined significance, ASC-US)和低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion, LSIL)的分流;甲基化检测可用于12 HR-HPV阳性人群的分流。根据目前我国研究结果,HPV基因整合检测也可用于HR-HPV初筛阳性的分流。以上新的检测方法均需选择经国内外权威机构认可、临床试验验证有相关适应证的试剂。HPV拓展分型或HPV载量等其他方法还需积累更多的临床证据。In response to the incidence of cervical intraepithelial neoplasia and cervical cancer in China and global screening strategies,a collaborative effort was undertaken by seven Chinese medical societies to develop this guidelineⅡfor cervical cancer screening.This guide focuses on standardizing methods for triaging abnormal cervical cancer screening results,with the aim of reducing overdiagnosis and missed diagnosis through refined management.Cervical cytology is currently the main triage method for individuals with positive high-risk human papillomavirus(HR-HPV)detection.Primary screening with cytology is managed based on the different risks of their results.In addition,p16/Ki-67 dual stain(DS)is acceptable for triage HPV-positive test results without genotyping or those positive for other(non-16/18)HR-HPV types(12 HR-HPV).It can also be used for triage in co-testing with HPV-positive results(no genotyping or 12 HR-HPV)when the cytology result shows NILM,ASC-US and LSIL.Methylation is acceptable for triage of individuals testing 12 HR-HPV-positive.HPV gene integration testing could be used for the triage of HR-HPV positive individuals based on current research results in China.All these new testing methods must utilize reagents that have been approved by authoritative institutions and clinically validated for relevant indications.Additional clinical evidence is required for other methods such as HPV extended genotyping or HPV viral load,etc.

关 键 词：子宫颈癌 筛查 分流 方法 指南 

分 类 号：R737.33[医药卫生—肿瘤]