Cervical cancer(CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas,the burden from disease remains important because o...Cervical cancer(CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas,the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies,researchers have attempted to find new strategies that are adapted to low- and middle-income countries(LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus(HPV) testing is more effective than cytology for CC screening. Therefore,highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages,HPV-based screening has a low positive predictive value for CC,so that HPVpositive women need to be triaged with further testing to determine optimal management. Visual inspection tests,cytology and novel biomarkers are some options. In this review,we provide an overview of current and emerging screening approaches for CC. In particular,we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care(POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress,but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.展开更多
目的了解个旧地区妇女高危型人乳头状瘤病毒(high-risk human papillomavirus,HR-HPV)流行情况,探讨HR-HPV检测在宫颈病变筛查和预防宫颈癌中的价值。方法以个旧市妇幼保健院妇科门诊就诊患者为观察对象,进行HR-HPV检测和病理学活检,以...目的了解个旧地区妇女高危型人乳头状瘤病毒(high-risk human papillomavirus,HR-HPV)流行情况,探讨HR-HPV检测在宫颈病变筛查和预防宫颈癌中的价值。方法以个旧市妇幼保健院妇科门诊就诊患者为观察对象,进行HR-HPV检测和病理学活检,以病理学诊断为金标准,以灵敏度、特异度、准确度、约登指数、假阳性率、假阴性率等为评价指标,评价HPV检测在宫颈病变筛查中的价值。结果分析了625例筛查对象,其中宫颈病变患者99例(15.8%),HR-HPV感染者302例(48.3%)。不同级别宫颈病变与HR-HPV感染率之间呈显著性正相关(r=0.728,P<0.05)。不同级别宫颈病变患病率,与年龄、孕次、产次呈显著性正相关(P<0.05),与性交开始年龄之间呈显著性负相关(P<0.05)。妇女宫颈病变患者、HR-HPV感染者和病毒载量三项指标多因素分析结果,宫颈病变以农村妇女和多性伴者为高发人群(P<0.05);HR-HPV感染以农村妇女为高发人群(P<0.05);HR-HPV病毒载量以多次妊娠者为高发人群(P<0.05)。宫颈病变级别与HPV病毒载量中位数呈显著性正相关(P<0.05)。结论 HR-HPV检测在宫颈病变筛查中具有较高的灵敏度、特异度,在筛查宫颈病变和预防宫颈癌中具有较高的临床价值。展开更多
文摘Cervical cancer(CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas,the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies,researchers have attempted to find new strategies that are adapted to low- and middle-income countries(LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus(HPV) testing is more effective than cytology for CC screening. Therefore,highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages,HPV-based screening has a low positive predictive value for CC,so that HPVpositive women need to be triaged with further testing to determine optimal management. Visual inspection tests,cytology and novel biomarkers are some options. In this review,we provide an overview of current and emerging screening approaches for CC. In particular,we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care(POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress,but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.
文摘目的了解个旧地区妇女高危型人乳头状瘤病毒(high-risk human papillomavirus,HR-HPV)流行情况,探讨HR-HPV检测在宫颈病变筛查和预防宫颈癌中的价值。方法以个旧市妇幼保健院妇科门诊就诊患者为观察对象,进行HR-HPV检测和病理学活检,以病理学诊断为金标准,以灵敏度、特异度、准确度、约登指数、假阳性率、假阴性率等为评价指标,评价HPV检测在宫颈病变筛查中的价值。结果分析了625例筛查对象,其中宫颈病变患者99例(15.8%),HR-HPV感染者302例(48.3%)。不同级别宫颈病变与HR-HPV感染率之间呈显著性正相关(r=0.728,P<0.05)。不同级别宫颈病变患病率,与年龄、孕次、产次呈显著性正相关(P<0.05),与性交开始年龄之间呈显著性负相关(P<0.05)。妇女宫颈病变患者、HR-HPV感染者和病毒载量三项指标多因素分析结果,宫颈病变以农村妇女和多性伴者为高发人群(P<0.05);HR-HPV感染以农村妇女为高发人群(P<0.05);HR-HPV病毒载量以多次妊娠者为高发人群(P<0.05)。宫颈病变级别与HPV病毒载量中位数呈显著性正相关(P<0.05)。结论 HR-HPV检测在宫颈病变筛查中具有较高的灵敏度、特异度,在筛查宫颈病变和预防宫颈癌中具有较高的临床价值。
