子宫颈癌的筛查方法

,;;R737.33A1672-4992-(2008)03-0462-03,,,,46.6,80%,13[1]200249.3,27.4[2],80%[3](CIN)10(WHO)CINIC1NIICINIII3-8,CINI0.69%-6.2%,C1NII4.3%-13.3%,CINIII12%-65%[4],590%,[5]1941,,70%[6]50,,7010.7/10902.89/10,63.84%[4],1262,CIN61.7%,74.9%,77.4%,524.74%,[7]1960,197513.4/1019987.2/10,196212.1/1019944/10,66.6%[8],1991-19931998-2000,20-6933%[9],197314.2/1019947.8/10[10],[11],,,,,85%,[12]11.1,40GeorgePapanicolaou2007-04-16,330006(1974-),,,,,,,:,,,,,1.2(HPV-DNA)(HPV)[13],HPVDNA95%-100%75%-95%HPV110,HPV13(16,18,31,33,35,39,45,51,52,56,58,59,68),HPV5(6,11,42,43,44)HPV:Southern(PCR)(HC)PCR,,,,,,HPV,HC-9HPV,HC-13HPV,1.3,(VIA)(VILI):3%-5%,DNA,,:,CIN,,,,CIN90[14]264MODERNONCOLOGY,Mar12008,VOI116,NO13©1994-2008ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.:;,50%,,,1.6,1.7,:;;(LEEP),2,‰,1,HPVDNA[16-17],,,[16,20-22],,,,Frable[23]15%-20%,50%,,;,,,,,,99%[24],,,5%,[17];[19-22];[18],[15],,2/3,,,,(ACCP)[25-26]1[15]VILI53.13%82.19%56.25%79.09%l[16]HPVDNA90.5%81.1%87.2%90.5%79.1%58.3%VIA53.1%62.1%42.6%67.2%[17]HPVDNA83.5%85.9%87.2%93.5%HPVDNA95.2%85.9%VIA70.9%74.3%81.4%76.5%91%9%Sangwa-Lugoma[18]VIA*55.5%64.6%VILI*44%74.6%VIA71.1%71.3%VILI68.3%76.2%SankaranarayananR[19]VIA88.6%78%VIA82.6%86.5%VILI87.2%84.7%81.9%87.8%SankaranarayananR[20]VIA92.2%91.3%lGhaemmaghamiF[21]VIA74.3%94%72%90.2%Elitl[22]VIA82.9%88.6%88.6%98.5%*lCINI,lCINII,HPV,98%,,99%-100%[12],[27]HPV,,,[28]VIAVILIHC-100%,99.8%,VIA,,VILI,,[10]36420083163©1994-2008ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.[29]3123-2004:505,25-493-5VILIVIA,,,,,,-,,,,3/4,,,[1]ParkinDM,BrayF,FedayJ,etal.Estimatingtheworldcalleerbur2den:Globocan2000[J].IntJCancer,2001,94(2):153-156.[2]ParkinDM,BrayF,FerlayJ,etal.Globalcancerstatistics,2002[J].CACancerJClin,2005,55(2):74-108.[3]MandelblattJS,LawrenceWF,GaffikinL,etal.Costsandbenefitsofdifferentstrategiestoscreenforcervicalcancerinless-developedcountries[J].JNatlCancerInst,2002,94(19):1469-1483.[4],,,.7090[J].,2005,25(4):386-390.[5].[M].:,1995:154-156.[6]KossLG.ThePapanicolaoutestforcervicalcancerdetection.Atri2umphandatragedy[J].JAMA,1989,26l(5):737-743.[7],.[J].,2005,19(5):43-45.[8]IokaA,TsukumaH,AjikiW,etal.Trendsinuterinecancerinci2denceinJapan1975-98[J].JpnJClinOncol,2003,33(12):645-646.[9]CanfellK,SitasF,BeralV.CervicalcancerinAustraliaandtheU2nitedKingdom:comparisonofscreeningpolicyanduptake,andcancerincidenceandmortality[J].MedJAust,2006,185(9):482-486.[10]U.S.PreventiveServicesTaskForce.Screeningforcervicalcanc2er:recommendationsandrationale[J].AmFamPhysician,2003,67(8):1759-1766.[11].[M].:,2002:89-105.[12].[M].:,2004:231-233.[13]WalboomersJM,JacobsMV,ManosMM,etal.Humanpapilloma2virusisanecessarycauseofinvasivecervicalcancerworldwide.[J].JPathol,1999,189(1):12-19.[14]GaffikinL,BlumenthalPD,McGrathJ,etal.Visualinspectionwithaceticacidforcervical-cancerscreening:testqualitiesinaprima2ry-caresetting[J].Lancet,1999,353(9156):869-873.[15],,,.[J].,2006,27(1):15-18.[16],,,.[J].,2006,35(7):842-843.[17],,,.[J].,2002,24(1):50-53.[18]Sangwa-LugomaG,MahmudS,NasrSH,etal.Visualinspectionasacervicalcancerscreeningmethodinaprimaryhealthcareset2tinginAfrica[J].IntJCancer,2006,119(6):1389-1395.[19]SankaranarayananR,WesleyR,TharaS,etal.Testcharacteristicsofvisualinspectionwith4%aceticacid(VIA)andLugol’siodine(VILI)incervicalcancerscreeninginKerala,India[J].IntJCancer,2003,106(3):404-408.[20]VSankaranarayananR,WesleyR,SomanathanT,etal.Visualin2spectionoftheuterinecervixaftertheapplicationofaceticacidinthedetectionofcervicalcarcinomaanditsprecursors[J].Cancer,1998,83(10):2150-2156.[21]GhaemmaghamiF,BehtashN,ModaresGilaniM,etal.Visualin2spectionwithaceticacidasafeasiblescreeningtestforcervicalne2oplasiainIran[J].IntJGynecolCancer,2004,14(3):465-469.[22]ElitL,BaigalG,TanJ,etal.Assessmentof2cervicalscreeningmethodsinMongolia:cervicalcytologyandvisualinspectionwithaceticacid[J].JLowGenitTractDis,2006,10(2):83-88.[23]FrableWJ,AustinRM,GreeningsSE,etal.Medicolegalaffairs:IACtaskforcesummary.DiagnosticCytologyTowardsthe21stCentury:AnInternationalExpertConferenceandTutorial[J].Ac2taCytol,1998,42(1):76-119.[24]WenC.hinaplanstocurbcervicalcancer[J].LancetOncol,2005,6(3):139-141.[25]BlumenthalPD,LauterbachM,SellorsJW,etal.Trainingforcervicalcancerpreventionprogramsinlow-resourcesettings:fo2cusonvisualinspectionwithaceticacidandcryotherapy[J].IntJGynaecolObstet,2005,89(suppl2)S30-37.[26]TsuVD,PollackAE.Preventingcervicalcancerinlow-resourcesettings:howfarhavewecomeandwhatdoesthefuturehold[J]?IntJGynaecolObstet,2005,89(suppl2)S55-59.[27],,,.[J].,2001,28(4):253-255.[28]SarianLO,DerchainSF,NaudP,etal.Evaluationofvisualinspec2tionwithaceticacid(VIA),Lugol’siodine(VILI),cervicalcy2tologyandHPVtestingascervicalscreeningtoolsinLatinAmerica[J].JMedScreen,2005,12(3):142-149.[29]SawayaGF,KerlikowskeK,LeeNC,etal.Frequencyofcervicalsmearabnormalitieswithin3yearsofnormalcytology[J].ObstetGynecol,2000,96(2):219-223.464MODERNONCOLOGY,Mar12008,VOI116,NO13©1994-