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干货:HPV可否成为宫颈癌筛查**方案(全新宫颈癌筛查攻略:ASCCP/SGO会议纪要)

2015-12-22 Tellgen 透景诊断

导读:2015年最新宫颈癌筛查指南出台,HPV检测开始成为宫颈癌筛查的主角,细胞学检测成为辅助筛查方法。最新指南的制定是基于2014年2月17日美国妇科肿瘤(SGO)和美国阴道镜及宫颈病理协会(ASCCP)联合发去的专家会议,此次会议主要探讨以HPV检测为主的方法能否作为现行宫颈癌筛查的替代方案。会议肯定了HPV检测更加灵敏,阴性结果更加安全...... 组委会成员 13名各大

导读:2015年最新宫颈癌筛查指南出台,HPV检测开始成为宫颈癌筛查的主角,细胞学检测成为辅助筛查方法。最新指南的制定是基于2014年2月17日美国妇科肿瘤(SGO)和美国阴道镜及宫颈病理协会(ASCCP)联合发去的专家会议,此次会议主要探讨以HPV检测为主的方法能否作为现行宫颈癌筛查的替代方案。会议肯定了HPV检测更加灵敏,阴性结果更加安全......

组委会成员

13名各大权威机构的代表专家:美国妇科肿瘤协会,美国阴道镜及宫颈病理协会,美国妇产科医生协会,美国癌症协会和美国细胞病理协会等。

会前准备

检索2011年至2014年发表的与HPV,宫颈癌,筛查方案相关的所有研究资料,包括2011年前重大试验研究成果。每份纳入分析的研究都需3名专家同时确认。

会议主要讨论问题

1、以HPV检测为主的宫颈癌初筛方法是否与基于细胞学的筛查方法一样安全有效?

答案:HPV检测阴性的人群发展至CIN3+风险更低,以HPV检测为主的宫颈癌初筛方法至少和细胞学筛查方法一样安全有效,目前美国已经接受将HPV检测作为25岁以上妇女宫颈癌筛查方案之一,筛查间隔为3年。

论据1:Dillner等人总结7项欧洲宫颈癌筛查试验的随访数据,对比分析细胞学和HPV检测阴性结果后3年的累积CIN3+发病率。结果发现细胞学阴性时3年CIN3+累积发病率为0.5%而HPV阴性时只有0.11%。

论据2:Katki等人对超过30万人次的大型妇女宫颈癌筛查进行为期6年的随访,发现HPV检测阴性时3年间CIN3+累积发病率更低。

论据3:2014年,Ronco等人总结4大以HPV检测为主的宫颈癌筛查试验随访数据。其中1项研究为单独HPV检测,其余3项为细胞学联合HPV筛查。结果发现随访2年半间,以HPV为主的筛查人群和以细胞学为主的筛查人群宫颈癌发病率没有明显不同。但2年半以后的随访数据表明前者的浸润癌发生率显著低于后者。

论据4:美国超过4万妇女的宫颈癌筛查ATHENA试验结果发现采用HPV检测作为宫颈癌初筛方法,CIN3+的检出率约提高50%。

2、HPV检测能否作为美国现行浸润癌筛查的并行方案?

答案:因为HPV检测作为宫颈癌初筛方法至少和目前基于细胞学检测的筛查方案一样安全有效,甚至更好,所以可以考虑作为现行宫颈癌筛查的替代方法。

3、以HPV检测为主的宫颈癌初筛方案应该如何管理HPV阳性结果?

答案:根据现有的研究数据,对于HPV阳性结果患者管理如下:HPV16,18阳性时转诊阴道镜;其他HPV高危12型别阳性时联合细胞学检测进行阴道镜分流管理,如图所示:

4、HPV检测作为宫颈癌初筛方案时最佳筛查间隔是几年?

答案:组委会建议HPV检测作为宫颈癌筛查方案时,筛查间隔不应低于3年。

论据1: Ronco等人分析了四分之三的欧洲大型宫颈癌筛查数据,发现5年一次的HPV检测至少比3年一次的细胞学检测更加安全,推荐HPV筛查间隔为3年。
论据2:美国ATHENA试验只随访了3年,发现HPV检测阴性结果时,3年间CIN3+的累积发病率少于1%,推荐HPV筛查间隔最佳为3年。

5、HPV检测作6、HPV检7、未来探索
结论

1、HPV检测作为宫颈癌初筛方法是科学和临床的重要进展,在相同的筛查间隔内,HPV检测相对于细胞学更加安全。HPV检测可以作为目前现行宫颈癌筛查(细胞学或联合检测)的可选方法。

2、以HPV检测为主的最新宫颈癌筛查方案:HPV16,18阳性转诊阴道镜,联合细胞学检测作为其他12种高危型别阳性时的分流管理。

3、HPV初筛可提高25-29岁年龄段的CIN3+检出率,但同样增加了阴道镜检测数目。临床需要谨慎决策,降低不必要的阴道镜检测。

4、尽管还需要大量的研究来进一步确认筛查方案,但HPV作为宫颈癌初筛方案无疑可以进一步降低美国宫颈癌的发病率和死亡率。


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    2016-09-23 quxin068
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    2016-11-17 zutt
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  4. [GetPortalCommentsPageByObjectIdResponse(id=1938525, encodeId=6920193852568, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Fri Sep 23 16:34:00 CST 2016, time=2016-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987640, encodeId=fb03198e640dc, content=<a href='/topic/show?id=67dd1596982' target=_blank style='color:#2F92EE;'>#SCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15969, encryptionId=67dd1596982, topicName=SCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=742793, createdName=zutt, createdTime=Thu Nov 17 00:34:00 CST 2016, time=2016-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2084028, encodeId=72bc20840282a, content=<a href='/topic/show?id=c92d2582476' target=_blank style='color:#2F92EE;'>#会议纪要#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25824, encryptionId=c92d2582476, topicName=会议纪要)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Thu Mar 03 15:34:00 CST 2016, time=2016-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2040142, encodeId=c849204014201, content=<a href='/topic/show?id=3cb21623358' target=_blank style='color:#2F92EE;'>#SGO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16233, encryptionId=3cb21623358, topicName=SGO)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=674961, createdName=tamgche, createdTime=Thu Jan 21 23:34:00 CST 2016, time=2016-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1780042, encodeId=c2991e80042de, content=<a href='/topic/show?id=c1942821df' target=_blank style='color:#2F92EE;'>#ASCCP/SGO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2821, encryptionId=c1942821df, topicName=ASCCP/SGO)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4723380, createdName=yangcx0915, createdTime=Sun Jun 26 14:34:00 CST 2016, time=2016-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=54686, encodeId=481654686c5, content=好东西,值得分享,学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=69b61619007, createdName=andruhn, createdTime=Fri Jan 08 19:38:00 CST 2016, time=2016-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407963, encodeId=f4ec140e96379, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Thu Dec 24 00:34:00 CST 2015, time=2015-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1448921, encodeId=4b2e14489212c, content=<a href='/topic/show?id=2dcd4631494' target=_blank style='color:#2F92EE;'>#宫颈癌筛查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46314, encryptionId=2dcd4631494, topicName=宫颈癌筛查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0415457691, createdName=般若傻瓜, createdTime=Thu Dec 24 00:34:00 CST 2015, time=2015-12-24, status=1, ipAttribution=)]
    2016-01-21 tamgche
  5. [GetPortalCommentsPageByObjectIdResponse(id=1938525, encodeId=6920193852568, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Fri Sep 23 16:34:00 CST 2016, time=2016-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987640, encodeId=fb03198e640dc, content=<a href='/topic/show?id=67dd1596982' target=_blank style='color:#2F92EE;'>#SCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15969, encryptionId=67dd1596982, topicName=SCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=742793, createdName=zutt, createdTime=Thu Nov 17 00:34:00 CST 2016, time=2016-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2084028, encodeId=72bc20840282a, content=<a href='/topic/show?id=c92d2582476' target=_blank style='color:#2F92EE;'>#会议纪要#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25824, encryptionId=c92d2582476, topicName=会议纪要)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Thu Mar 03 15:34:00 CST 2016, time=2016-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2040142, encodeId=c849204014201, content=<a href='/topic/show?id=3cb21623358' target=_blank style='color:#2F92EE;'>#SGO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16233, encryptionId=3cb21623358, topicName=SGO)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=674961, createdName=tamgche, createdTime=Thu Jan 21 23:34:00 CST 2016, time=2016-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1780042, encodeId=c2991e80042de, content=<a href='/topic/show?id=c1942821df' target=_blank style='color:#2F92EE;'>#ASCCP/SGO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2821, encryptionId=c1942821df, topicName=ASCCP/SGO)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4723380, createdName=yangcx0915, createdTime=Sun Jun 26 14:34:00 CST 2016, time=2016-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=54686, encodeId=481654686c5, content=好东西,值得分享,学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=69b61619007, createdName=andruhn, createdTime=Fri Jan 08 19:38:00 CST 2016, time=2016-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407963, encodeId=f4ec140e96379, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Thu Dec 24 00:34:00 CST 2015, time=2015-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1448921, encodeId=4b2e14489212c, content=<a href='/topic/show?id=2dcd4631494' target=_blank style='color:#2F92EE;'>#宫颈癌筛查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46314, encryptionId=2dcd4631494, topicName=宫颈癌筛查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0415457691, createdName=般若傻瓜, createdTime=Thu Dec 24 00:34:00 CST 2015, time=2015-12-24, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1938525, encodeId=6920193852568, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Fri Sep 23 16:34:00 CST 2016, time=2016-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987640, encodeId=fb03198e640dc, content=<a href='/topic/show?id=67dd1596982' target=_blank style='color:#2F92EE;'>#SCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15969, encryptionId=67dd1596982, topicName=SCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=742793, createdName=zutt, createdTime=Thu Nov 17 00:34:00 CST 2016, time=2016-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2084028, encodeId=72bc20840282a, content=<a href='/topic/show?id=c92d2582476' target=_blank style='color:#2F92EE;'>#会议纪要#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25824, encryptionId=c92d2582476, topicName=会议纪要)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Thu Mar 03 15:34:00 CST 2016, time=2016-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2040142, encodeId=c849204014201, content=<a href='/topic/show?id=3cb21623358' target=_blank style='color:#2F92EE;'>#SGO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16233, encryptionId=3cb21623358, topicName=SGO)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=674961, createdName=tamgche, createdTime=Thu Jan 21 23:34:00 CST 2016, time=2016-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1780042, encodeId=c2991e80042de, content=<a href='/topic/show?id=c1942821df' target=_blank style='color:#2F92EE;'>#ASCCP/SGO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2821, encryptionId=c1942821df, topicName=ASCCP/SGO)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4723380, createdName=yangcx0915, createdTime=Sun Jun 26 14:34:00 CST 2016, time=2016-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=54686, encodeId=481654686c5, content=好东西,值得分享,学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=69b61619007, createdName=andruhn, createdTime=Fri Jan 08 19:38:00 CST 2016, time=2016-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407963, encodeId=f4ec140e96379, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Thu Dec 24 00:34:00 CST 2015, time=2015-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1448921, encodeId=4b2e14489212c, content=<a href='/topic/show?id=2dcd4631494' target=_blank style='color:#2F92EE;'>#宫颈癌筛查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46314, encryptionId=2dcd4631494, topicName=宫颈癌筛查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0415457691, createdName=般若傻瓜, createdTime=Thu Dec 24 00:34:00 CST 2015, time=2015-12-24, status=1, ipAttribution=)]
    2016-01-08 andruhn

    好东西,值得分享,学习了!

    0

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    2015-12-24 一闲
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