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评估细胞学、HR-HPV在阴道镜检查中发生宫颈癌前病变风险的分层研究

张一方,  薛鹏,  唐朝,  李晴,  江宇,  乔友林

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文章导航 > 中华疾病控制杂志  > 2021 >  25(7): 812-816, 842
张一方, 薛鹏, 唐朝, 李晴, 江宇, 乔友林. 评估细胞学、HR-HPV在阴道镜检查中发生宫颈癌前病变风险的分层研究[J]. 中华疾病控制杂志, 2021, 25(7): 812-816, 842. doi: 10.16462/j.cnki.zhjbkz.2021.07.014
引用本文: 张一方, 薛鹏, 唐朝, 李晴, 江宇, 乔友林. 评估细胞学、HR-HPV在阴道镜检查中发生宫颈癌前病变风险的分层研究[J]. 中华疾病控制杂志, 2021, 25(7): 812-816, 842. doi: 10.16462/j.cnki.zhjbkz.2021.07.014
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ZHANG Yi-fang, XUE Peng, TANG Chao, LI Qing, JIANG Yu, QIAO You-lin. Risk stratification study of assessing cervical precancer by cytology, high risk human papillomavirus in colposcopy examination[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2021, 25(7): 812-816, 842. doi: 10.16462/j.cnki.zhjbkz.2021.07.014
Citation: ZHANG Yi-fang, XUE Peng, TANG Chao, LI Qing, JIANG Yu, QIAO You-lin. Risk stratification study of assessing cervical precancer by cytology, high risk human papillomavirus in colposcopy examination[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2021, 25(7): 812-816, 842. doi: 10.16462/j.cnki.zhjbkz.2021.07.014
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评估细胞学、HR-HPV在阴道镜检查中发生宫颈癌前病变风险的分层研究

doi: 10.16462/j.cnki.zhjbkz.2021.07.014
  • 1.

    100730 北京，中国医学科学院/北京协和医学院群医学及公共卫生学院

  • 2.

    518048 深圳，南方医科大学附属深圳市妇幼保健院子宫颈疾病诊治中心

张一方和薛鹏为共同第一作者
基金项目: 

中国医学科学院医学与健康科技创新工程项目 CIFMS2017-I2M-B & R-03

详细信息
    通讯作者:

    李晴，E-mail：liqing1350@foxmail.com

    江宇，E-mail: jiangyu@pumc.edu.cn

  • 中图分类号: R737.33

Risk stratification study of assessing cervical precancer by cytology, high risk human papillomavirus in colposcopy examination

  • 1.

    School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

  • 2.

    Diagnosis and Treatment for Cervical Lesions Center, Shenzhen Maternity and Child Healthcare Hospital, Affiliated Hospital of the South Medical University, Shenzhen 518048, China

ZHANG Yi-fang and XUE Peng contributed equally to this article.
Funds: 

The Chinese Academy of Medical Science Initiative for Innovative Medicine CIFMS2017-I2M-B & R-03

More Information

    摘要
  • 摘要:   目的  评估细胞学、高危型人乳头瘤病毒(high risk human papillomavirus, HR-HPV)与阴道镜结果的不同组合发生宫颈上皮内瘤变≥2级(cervical intraepithelial neoplasia grade 2 or worse, CIN2+)的风险。  方法  选取2018年1月-2018年12月深圳市妇幼保健院阴道镜门诊数据库中822例患者的临床数据资料，基于细胞学、HR-HPV和阴道镜结果，分析患者发生CIN2+的风险差异。  结果  若发现其中两种检查结果高度异常(细胞学高度上皮内瘤变及以上(high-grade squamous intraepithelial lesion or worse, HSIL+)、HPV16/18+、阴道镜高级别病变)，则发生CIN2+的风险高于60%；若发现三种高度异常，则发生CIN2+的风险为97.1%。  结论  当发现细胞学、HR-HPV和阴道镜结果中≥2种异常情况，未来进展为CIN2+的风险较高，应予以重视，减少不必要的误诊和漏诊。
    Abstract:   Objective  To evaluate pooled risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) based on the various combinations of cytology, HR-HPV (high risk human papillomavirus), and colposcopy impression.  Methods  A total of 822 cases were selected from the colposcopy outpatient database of Shenzhen Maternity & Child Healthcare Hospital from January to December 2018. We assessed the risk of CIN2+ based on the combinations of three test results (cytology, HR-HPV, and colposcopy).  Results  If two of the test results were found highly abnormality (HSIL+, HPV16/18+ and high-grade colposcopic impression), the risks for CIN2+ was higher than 60%. If three highly abnormal test results were found, the risk for CIN2+ was 97.1%.  Conclusio  When at least two abnormal results in cytology HR-HPV and colposcopy are found, the CIN2+ risk was quite high. Attention should be paid to reduce unnecessary misdiagnosis and missed diagnosis.
    • HTML全文

  • 表  1  细胞学、HR-HPV及阴道镜检查的不同组合发生CIN2+的风险

    Table  1.   Risk estimates for CIN2+ in different combinations of cytology, HR-HPV and colposcopy impression

    组别 阴道镜检查 细胞学 HR-HPV 病理组织学CIN2+(人) 总计(人) 风险(95% CI)值
    A1 高级别病变 HSIL+ HPV16/18+ 34 35 0.971(0.851~0.999)
    A2 低级别病变 HSIL+ HPV16/18+ 10 11 0.909(0.587~0.998)
    A3 低级别病变 HSIL+ 其他HR-HPV+ 16 19 0.842(0.604~0.966)
    A4 高级别病变 HSIL+ 其他HR-HPV+ 3 4 0.750(0.194~0.994)
    A5 高级别病变 < HSIL HPV16/18+ 122 176 0.693(0.619~0.760)
    A6 高级别病变 < HSIL 其他HR-HPV+ 11 31 0.355(0.192~0.546)
    A7 低级别病变 < HSIL HPV16/18+ 98 334 0.293(0.245~0.355)
    A8 正常/良性 < HSIL HPV16/18+ 7 28 0.250(0.107~0.449)
    A9 低级别病变 < HSIL 其他HR-HPV+ 23 151 0.152(0.099~0.220)
    A10 低级别病变 < HSIL 阴性 1 15 0.067(0.002~0.319)
    A11 正常/良性 < HSIL 其他HR-HPV+ 1 17 0.059(0.001~0.287)
    A12 正常/良性 < HSIL 阴性 0 1 0.000(0.000~0.975)
    A13 高级别病变 HSIL+ 阴性
    A14 高级别病变 < HSIL 阴性
    A15 低级别病变 HSIL+ 阴性
    A16 正常/良性 HSIL+ HPV16/18+
    A17 正常/良性 HSIL+ 其他HR-HPV+
    A18 正常/良性 HSIL+ 阴性
    下载: 导出CSV

    表  2  细胞学与阴道镜检查的不同组合CIN2+的风险

    Table  2.   Risk estimates for CIN2+ in different combinations of cytology and colposcopy impression

    组别 阴道镜检查 细胞学 病理组织学CIN2+(人) 总计(人) 风险(95% CI)值
    B1 高级别病变 HSIL+ 37 39 0.949(0.827~0.994)
    B2 低级别病变 HSIL+ 26 30 0.867(0.693~0.962)
    B3 高级别病变 < HSIL 133 207 0.643(0.573~0.708)
    B4 低级别病变 < HSIL 122 500 0.244(0.207~0.284)
    B5 正常/良性 < HSIL 8 46 0.174(0.078~0.314)
    B6 正常/良性 HSIL+
    下载: 导出CSV

    表  3  HR-HPV与阴道镜检查的不同组合发生CIN2+的风险

    Table  3.   Risk estimates for CIN2+ in different combinations of HR-HPV and colposcopy impression

    组别 阴道镜检查 HR-HPV 病理组织学CIN2+(人) 总计(人) 风险(95% CI)值
    C1 高级别病变 HPV16/18+ 156 211 0.739(0.675~0.797)
    C2 高级别病变 其他HR-HPV+ 14 35 0.400(0.239~0.579)
    C3 低级别病变 HPV16/18+ 108 345 0.311(0.264~0.365)
    C4 正常/良性 HPV16/18+ 7 28 0.250(0.107~0.449)
    C5 低级别病变 其他HR-HPV+ 39 170 0.229(0.169~0.300)
    C6 低级别病变 阴性 1 15 0.067(0.002~0.319)
    C7 正常/良性 其他HR-HPV+ 1 17 0.059(0.001~0.287)
    C8 正常/良性 阴性 0 1 0.000(0.000~0.975)
    C9 高级别病变 阴性
    下载: 导出CSV

    表  4  既往风险分层研究发生CIN2+的风险

    Table  4.   Pooled risk estimate of CIN2+ by strata of test results of previous studies

    组别 试验名称 年份 病理组织学CIN2+(人) 总计(人) 风险(95% CI)值
    D1 阴道镜检查高级别病变 & 细胞HSIL+ & HPV16/18+ ALTS 2017 90 105 0.857(0.778~0.918)
    Biopsy 2017 45 57 0.789(0.661~0.886)
    BD 2017 8 9 0.889(0.518~0.997)
    合计 143 171 0.836(0.772~0.888)
    D2 阴道镜检查低级别病变 & 细胞HSIL+ & HPV16/18+ ALTS 2017 78 116 0.672(0.579~0.757)
    Biopsy 2017 19 27 0.704(0.498~0.862)
    BD 2017 17 22 0.773(0.546~0.922)
    合计 114 165 0.691(0.614~0.760)
    D3 阴道镜检查高级别病变 & 细胞学HSIL+ & HPV16/18- ALTS 2017 31 49 0.633(0.483~0.766)
    Biopsy 2017 35 50 0.700(0.554~0.821)
    BD 2017 5 8 0.625(0.245~0.915)
    合计 71 107 0.664(0.566~0.752)
    D4 阴道镜检查高级别病变 & 细胞 < HSIL & HPV16/18+ ALTS 2017 43 75 0.573(0.454~0.687)
    Biopsy 2017 18 24 0.750(0.533~0.902)
    BD 2017 11 22 0.500(0.282~0.718)
    合计 72 121 0.595(0.502~0.683)
    D5 阴道镜检查正常/良性 & 细胞学 < HSIL & HPV16/18- ALTS 2017 20 543 0.370(0.230~0.560)
    Biopsy 2017 6 86 0.007(0.026~0.146)
    BD 2017 56 2 384 0.023(0.018~0.030)
    合计 82 3 013 0.027(0.022~0.034)
    下载: 导出CSV
    • 参考文献(25)
  • [1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. DOI: 10.3322/caac.21609.
    [2] 郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析[J]. 中华肿瘤杂志, 2019(1): 19-28. DOI: 10.3760/cma.j.issn.0253-3766.2019.01.005.

    Zheng RS, Sun KX, Zhang SW, et al. Report of cancer epidemiology in China, 2015[J]. Chin J Oncol, 2019(1): 19-28. DOI: 10.3760/cma.j.issn.0253-3766.2019.01.005.
    [3] 姜明月, 冯瑞梅, 王林, 等. 液基细胞学联合人乳头状瘤病毒核酸检测对宫颈癌筛查的效果评价[J]. 中华肿瘤杂志, 2018, 40(10): 750-756. DOI: 10.3760/cma.j.issn.0253-3766.2018.10.006.

    Jiang MY, Feng RM, Wang L, et al. Performance of combined liquid based cytology and HPV nucleic acid test for detecting cervical precancer among women attending screening[J]. Chin J Oncol, 2018, 40(10): 750-756. DOI: 10.3760/cma.j.issn.0253-3766.2018.10.006.
    [4] Demarco M, Cheung LC, Kinney WK, et al. Low risk of cervical cancer/precancer among most women under surveillance postcolposcopy[J]. J Low Genit Tract Dis, 2018, 22(2): 97-103. DOI: 10.1097/lgt.0000000000000382.
    [5] Pretorius RG, Belinson JL, Burchette RJ, et al. Key determinants of the value of random cervical biopsy at colposcopy[J]. J Low Genit Tract Dis, 2019, 23(4): 241-247. DOI: 10.1097/lgt.0000000000000485.
    [6] Vallapapan A, Chandeying N, Srijaipracharoen S, et al. The role of random cervical biopsies in addition to colposcopy-directed biopsies in detection of CIN2[J]. J Obstet Gynaecol, 2019, 39(2): 184-189. DOI: 10.1080/01443615.2018.1474186.
    [7] Xue P, Ng MTA, Qiao Y. The challenges of colposcopy for cervical cancer screening in LMICs and solutions by artificial intelligence[J]. BMC Med, 2020, 18(1): 169. DOI: 10.1186/s12916-020-01613-x.
    [8] Manley KM, Simms RA, Platt S, et al. Unsatisfactory colposcopy: clinical decision-making in conditions of uncertainty[J]. BMC Med Inform Decis Mak, 2017, 17(1): 125. DOI: 10.1186/s12911-017-0516-3.
    [9] Wentzensen N, Massad LS, Mayeaux EJ Jr, et al. Evidence-based consensus recommendations for colposcopy practice for cervical cancer prevention in the United States[J]. J Low Genit Tract Dis, 2017, 21(4): 216-222. DOI: 10.1097/lgt.0000000000000322.
    [10] Henry MR. The Bethesda System 2001: an update of new terminology for gynecologic cytology[J]. Clin Lab Med, 2003, 23(3): 585-603. DOI: 10.1016/s0272-2712(03)00053-2.
    [11] Wentzensen N, Schiffman M, Silver MI, et al. ASCCP Colposcopy Standards: Risk-Based Colposcopy Practice[J]. J Low Genit Tract Dis, 2017, 21(4): 230-234. DOI: 10.1097/lgt.0000000000000334.
    [12] Schiffman M. Randomized clinical trial on clinical management of ASCUS and LSIL (ALTS)[EB/OL]. (2018-08-10)[2020-11-25]. https://clinicaltrials.gov/ct2/show/results/NCT01131312?term=Schiffman+M&cond=Cervical+Cancer&cntry=US&draw=2&rank=2.
    [13] Wentzensen N, Walker J, Smith K, et al. A prospective study of risk-based colposcopy demonstrates improved detection of cervical precancers[J]. Am J Obstet Gynecol, 2018, 218(6): 604. e1-604. e8. DOI: 10.1016/j.ajog.2018.02.009.
    [14] Stoler MH, Wright TC Jr, Parvu V, et al. The onclarity Human Papillomavirus trial: design, methods, and baseline results[J]. Gynecol Oncol, 2018, 149(3): 498-505. DOI: 10.1016/j.ygyno.2018.04.007.
    [15] 赵昀, 魏丽惠. CSCCP关于中国宫颈癌筛查及异常管理相关问题专家共识解读[J]. 实用妇产科杂志, 2018, 34(2): 101-104. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ201802011.htm

    Zhao Y, Wei MH. Interpretation and consensus on cervical cancer screening and abnormal management in China by CSCCP[J]. J Pract Obstet Gynecol, 2018, 34(2): 101-104. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ201802011.htm
    [16] 陈飞, 尤志学, 隋龙, 等. 阴道镜应用的中国专家共识[J]. 中华妇产科杂志, 2020, 55(7): 443-449. DOI: 10.3760/cma.j.cn112141-20200320-00240.

    Chen F, You ZX, Sui L, et al. Chinese experts on colposcopy application[J]. Chin J Obstet Gynecol, 2020, 55(7): 443-449. DOI: 10.3760/cma.j.cn112141-20200320-00240.
    [17] 乔友林. 中国宫颈癌防治任重而道远[J]. 中华肿瘤杂志, 2018, 40(10): 721-723. DOI: 10.3760/cma.j.issn.0253-3766.2018.10.001.

    Qiao YL. A long journey of cervical cancer prevention in China[J]. Chin J Oncol, 2018, 40(10): 721-723. DOI: 10.3760/cma.j.issn.0253-3766.2018.10.001.
    [18] Stuebs FA, Schulmeyer CE, Mehlhorn G, et al. Accuracy of colposcopy-directed biopsy in detecting early cervical neoplasia: a retrospective study[J]. Arch Gynecol Obstet, 2019, 299(2): 525-532. DOI: 10.1007/s00404-018-4953-8.
    [19] Zhang X, Dou Y, Wang M, et al. A retrospective analysis on 1901 women with high grade cervical intraepithelial neoplasia by colposcopic biopsy[J]. Eur J Obstet Gynecol Reprod Biol, 2017, 217: 53-58. DOI: 10.1016/j.ejogrb.2017.07.005.
    [20] Silver MI, Andrews J, Cooper CK, et al. Risk of cervical intraepithelial Neoplasia 2 or worse by cytology, Human Papillomavirus 16/18, and colposcopy impression: a systematic review and meta-analysis[J]. Obstet Gynecol, 2018, 132(3): 725-735. DOI: 10.1097/aog.0000000000002812.
    [21] 张莉, 热米拉·热扎克, 胡尚英, 等. 阴道镜结果正常或低度病变妇女发生宫颈癌前病变的前瞻性风险分层研究[J]. 中国肿瘤临床, 2019, 46(15): 768-772. DOI: 10.3969/j.issn.1000-8179.2019.15.549.

    Zhang L, Re ML·RZK, Hu SY, et al. Long-term risk stratification study of women with normal status or low-grade lesion identified by colposcopy[J]. Chin J Clin Oncol, 2019, 46(15): 768-772. DOI: 10.3969/j.issn.1000-8179.2019.15.549.
    [22] 贾芃, 裴志飞, 张岱, 等. 单纯HPV高危型感染者阴道镜操作策略初步探讨[J]. 中国妇产科临床杂志, 2019, 20(4): 292-295. DOI: 10.13390/j.issn.1672-1861.2019.04.002.

    Jia P, Pei ZF, Zhang D, et al. A pilot study to explore colposcopy biopsy protocol in high-risk HPV positive/cytology-negative patients[J]. Chin J Clin Obstet Gynecol, 2019, 20(4): 292-295. DOI: 10.13390/j.issn.1672-1861.2019.04.002.
    [23] Tidy JA, Lyon R, Ellis K, et al. The impact of age and high-risk human papillomavirus (hrHPV) status on the prevalence of high-grade cervical intraepithelial neoplasia (CIN2+) in women with persistent hrHPV-positive, cytology-negative screening samples: a prospective cohort study[J]. BJOG, 2020, 127(10): 1260-1267. DOI: 10.1111/1471-0528.16250.
    [24] 赵健, 郭雯雯, 杜亿杉, 等. 宫颈脱落细胞学检查高级别异常在阴道镜拟诊中的价值研究[J]. 中国实用妇科与产科杂志, 2020, 36(9): 850-854. DOI: 10.19538/j.fk2020090113.

    Zhao J, Guo WW, Du YS, et al. Value of high-risk cervical cytological abnormalities in colposcopy diagnosis[J]. Chin J Pract Gynecol Obstetr, 2020, 36(9): 850-854. DOI: 10.19538/j.fk2020090113.
    [25] Castle PE, Stoler MH, Wright TC Jr, et al. Performance of carcinogenic human papillomavirus (HPV) testing and HPV16 or HPV18 genotyping for cervical cancer screening of women aged 25 years and older: a subanalysis of the ATHENA study[J]. Lancet Onco, 2011, 12(9): 880-890. DOI: 10.1016/S1470-2045(11)70188-7.
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  • 收稿日期:  2020-11-30
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