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Can the careHPV test performed in mobile units replace cytology for screening in rural and remote areas?

乡村和偏远地区宫颈癌筛查可以用流动性工作单位中开展careHPV检测替代细胞学检查吗?

Lorenzi AT,Fregnani JH,Possati-Resende JC,Antoniazzi M,Scapulatempo-Neto C,Syrjänen S,Villa LL,Longatto-Filho A

Abstract

Human papillomavirus (HPV) DNA testing can be crucial for women who have limited access to traditional screening. The current study compared the results obtained through HPV DNA testing with those obtained through cytology-based screening.
A total of 3068 women aged 18 to 85 years were enrolled in an opportunistic cervical cancer screening program developed by the Barretos Cancer Hospital and performed by a team of health professionals working within a mobile unit from March to December 2012, followed by statistical analyses. For each patient, 2 different cervical samples were collected and preserved in a careHPV assay and SurePath medium, respectively.
High-risk HPV (hr-HPV) DNA was detected in 10.0% of women, with the majority (86.7%) demonstrating no abnormal Papanicolaou test results. The following cytological samples were found to be hr-HPV positive: 8.2% of the normal samples; 39.4% of the samples with atypical squamous/glandular cells of undetermined significance; 38.5% of the samples with atypical squamous/glandular cells of undetermined significance, cannot exclude high-grade lesion; 55.3% of the samples with low-grade squamous intraepithelial lesions; and 100% of the samples with high-grade squamous intraepithelial lesions. Colposcopy examinations were performed among 33.4% of the women with positive results on at least 1 of the tests (HPV DNA positive and/or cytology with atypical squamous/glandular cells of undetermined significance, cannot exclude high-grade lesion or high-grade squamous intraepithelial lesions), and 59.5% of these women underwent biopsies. Among these samples, 18.2% were confirmed as cervical intraepithelial neoplasia.
The careHPV test was demonstrated to be a feasible alternative to primary screening in low-resource settings accessed through the use of mobile units. Cancer Cytopathol 2016;124:581-8. © 2016 American Cancer Society.

摘要

对于通过传统宫颈细胞学检查进行宫颈癌筛查渠道有限的妇女来说,人乳头瘤病毒(HPV)DNA检测在她们的宫颈癌筛查中会是至关重要的。本研究对通过HPV DNA检测和基于细胞学检查的筛查结果进行了比较。
本研究中的受试者来自于Barretos癌症医院发起的机会性宫颈癌筛查计划,总共有3068名妇女纳入试验,其年龄在18到85岁之间,由一个专业性健康工作小组在一个流动性工作单位中进行,试验在2012年3月到11月之间进行,并对结果进行了统计学分析。每位受试者都接受了2次不同的宫颈细胞学取样,分别保存在careHPV试剂和SurePath液基细胞保存液中。

10.0%的妇女中检测到了高危亚型HPV (hr-HPV),其大多数(86.7%)被证实没有巴氏细胞学异常。其余hr-HPV患者的细胞学情况如下:8.2%的正常样本,39.4%的不能明确意义鳞状/腺上皮异常样本,38.5%的不能明确意义鳞状/腺上皮异常、不能除外高级别病变样本,55.3%的低级别鳞状上皮内病变样本,100%的高级别鳞状上皮内病变样本。具有至少一项阳性结果(阳性结果是指HPV DNA阳性和/或细胞学异常,后者包括不能明确意义的鳞状/腺上皮异常,不能除外高级别病变或高级别鳞状上皮内病变)的女性有33.4%接受了阴道镜检查,其中有59.5%接受了活检。这些活检样本中,其中18.2%被证实为有宫颈上皮内病变(CIN)。

经证实,在资源匮乏环境下进行宫颈癌初步筛查,通过利用移动工作单元开展careHPV检测是一种可行的替代方法。


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