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目的探索适合基层宫颈癌检查的服务模式和优化方案,完善适宜我国基层宫颈癌初筛的流程及筛查服务模式。方法选择2015年湖南省4个试点县21 806例采用HPV检测方法进行初筛和100 819例采取宫颈细胞学检查或醋酸染色检查/复方碘染色检查(VIA/VILI)进行初筛的做比较。试点项目中HPV检测结果阳性者进行宫颈细胞学检查,对宫颈细胞学检查结果可疑或异常者及肉眼检查异常者进行阴道镜检查,对阴道镜检查可疑或异常者提供组织病理学检查。而宫颈癌延续项目中对初筛异常及肉眼检查异常者进行阴道镜检查,对阴道镜检查可疑或异常者提供组织病理学检查。结果 HPV试点项目中筛查出HPV阳性3 429例,阳性检出率为15.72%。筛查出低级别病变(CINⅠ)49例,高级别病变(CINⅡ-Ⅲ)130例,微小浸润癌8例,浸润癌18例,其他恶性肿瘤1例,癌前病变率为596.17/10万,宫颈癌病变率为119.23/10万,早诊率为88.46%。宫颈癌延续项目筛查出低级别病变(CINⅠ)50例,高级别病变(CINⅡ-Ⅲ)129例,微小浸润癌12例,浸润癌30例,其他恶性肿瘤1例。宫颈癌延续项目中癌前病变率为127.95/10万,宫颈癌病变率为41.66/10万,早诊率为82.46%,明显低于HPV试点项目。结论以HPV作为农村宫颈癌项目初筛灵敏性更高,假阴性率更低。
Objective To explore the service mode and optimization plan for primary cervical cancer screening and to improve the screening and screening service suitable for primary screening of primary cervical cancer in China. Methods 21 806 cases from 4 pilot counties in Hunan Province in 2015 were screened by HPV test and 100 819 cervical cytology tests or acetic acid staining / compound iodine staining (VIA / VILI). HPV test results in the pilot project of cervical cytology, cervical cytology findings were suspicious or abnormal and macroscopic colposcopy colposcopy, colposcopy suspicious or abnormal provide histopathological examination. The continuation of the project of cervical cancer on the first screening abnormalities and macroscopic abnormalities colposcopy, colposcopy suspicious or abnormal histopathological examination. Results 3 429 HPV positive samples were screened out in the HPV pilot project, with a positive rate of 15.72%. 49 cases of low grade lesions (CINⅠ), 130 cases of high grade lesions (CINⅡ-Ⅲ), 8 cases of microinvasive carcinoma, 18 cases of invasive carcinoma, 1 case of other malignant tumors, the rate of precancerous lesions was 596.17 / Cervical cancer lesions was 119.23 / 100,000, the rate of early diagnosis was 88.46%. In the continuation of cervical cancer project, 50 cases of low grade lesions (CINⅠ), 129 cases of high grade lesions (CINⅡ-Ⅲ), 12 cases of microinvasive carcinoma, 30 cases of invasive carcinoma and 1 case of other malignant tumors were screened. Cervical cancer continuation project precancerous lesions rate was 127.95 / 100,000, cervical cancer rate was 41.66 / 100,000, the rate of early diagnosis was 82.46%, significantly lower than the HPV pilot project. Conclusion HPV screening as a rural cervical cancer project more sensitive screening, false negative rate is lower.