Abstract
Context .- Cervical cancer mortality has declined by 74% in the United States since the implementation of the Papanicolaou (Pap) test. Nevertheless, more than 12 000 US women annually develop cervical cancer, and squamous cell carcinoma (SqCa) remains the predominant cervical malignancy. Objective .- To evaluate screening techniques used in the detection of SqCa of the cervix and provide insights regarding which technique(s) is (are) most efficacious in our study population. Design .- We retrospectively reviewed all available cytologic, human papillomavirus (HPV), and histologic malignancy burden data from patients diagnosed with SqCa. The clinical data were collected from 2 geographically and socioeconomically diverse hospital systems. Cases in which identified patients had a Pap test with a negative result/unsatisfactory specimen within 5 years of SqCa tissue diagnosis were considered Pap test screening failures. Cases in which patients were diagnosed with HPV-negative SqCa were considered HPV screening failures. Results .- Eighty-eight cases (patients' ages ranging from 19 to 73 years) were identified. Of those, cytologic history was available for 64 cases present in our electronic medical history record. Three cases were cytology screening failures (one being an unsatisfactory specimen) and 3 cases were HPV screening failures (one being the cytologic unsatisfactory case). Although measuring sensitivity in practice has limitations, we calculated the SqCa detection sensitivity at 95.3% by Pap test alone and 97% when HPV DNA testing was incorporated. Conclusions .- Our results highlight the necessity of combining Pap and HPV testing. Although the number of cases identified is relatively small, our data suggest detection failures will decrease as the practice of combining HPV and Pap testing increases.
摘要
背景:自从开展巴氏(Pap)检查以来,美国宫颈癌的发病率下降了74%。尽管如此,美国每年发生宫颈癌的女性还是超过12000例,并且鳞状细胞癌(SqCa)仍然是最主要的宫颈恶性肿瘤。目的:评估用于检出宫颈SqCa的筛查技术,并就我们所研究的人群提出关于哪些技术是行之有效的一些观点。设计:我们回顾性复查了诊断为SqCa患者所有能够获取的细胞学、人类乳头瘤病毒(HPV)以及组织学恶性的相关数据。从地理区域和社会经济不同的2个医院收集临床数据。如果患者的巴氏检查结果为阴性或标本不满意、并且5年内组织学诊断为SqCa,则视为巴氏筛查失败。如果患者被诊断为HPV阴性SqCa,则视为HPV筛查失败。结果:我们确定出了88例(患者年龄范围19-73岁)。这些病例中,在我们的电子病历记录中能够获取细胞学病例的有64例。3例细胞学筛查失败(1例为不满意样本)、3例HPV筛查失败(1例为细胞学不满意病例)。虽然实际工作中检测敏感性具有局限性,但是我们计算的SqCa单独巴氏检查检测敏感性为95.3%,而联合HPV DNA检测敏感性为97%。结论:我们的结果突出了巴氏检查联合HPV检测的必要性。虽然确定出的病例样本量相对较小,但是我们的数据提示:当实践中加强HPV联合巴氏检测时,则检测失败的可能性将会降低。
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