澳大利亚新的 HPV 初筛中阴道镜检查的表现:如何确定阴道镜检查能力?

IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Jeffrey H.J. Tan, Deborah Neesham, Rebecca A. Szabo, Natalia Khomko, Desiree Yap, C. David H. Wrede
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引用次数: 0

摘要

目的:评估阴道镜的性能,并确定澳大利亚新的初级人类乳头瘤病毒(HPV)宫颈筛查计划的能力指标:对2017年12月1日至2020年7月31日期间在墨尔本皇家妇女医院阴道镜诊所就诊的4542名妇女进行回顾性观察研究:在首次阴道镜检查(FCV)后的两年内,25.1%的患者被检测出组织学CIN2+。大部分(86.7%)CIN2+是在就诊后六个月内早期发现的。阴道镜印象异常的活检率为 96.1%。在活检率较低的四位阴道镜医生中,只有一位能达到这一早期发现率。在反射细胞学阴性和阴道镜检查正常的病例中,超过 30% 的病例也进行了活检,在 HPV16/18 阳性病例中,有 5.0% 检测出 CIN2+,在 HPV16/18 非阳性病例中,有 3.8% 检测出 CIN2+。FCV 阴道镜检查高级别阴道印象的阳性预测值平均为 66.4%(阴道镜医师的预测值范围为 54.9%-81.6%),与 CIN2+ 的早期检出率关系不大。阴道镜检查的总体准确率为 84.5%(范围:78.7%-90.3%),这得益于新筛查算法的高反射性细胞学阴性转诊率所带来的高阴道镜真阴性预测,而且也不太可能成为阴道镜检查的有用指标:我们鼓励全国癌症筛查注册机构与参与筛查的阴道镜医师共同探讨这一问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Colposcopy performance in the new primary HPV screening in Australia: How to determine colposcopy competency?

Aims

To assess colposcopic performance and determine indicators for competency within the new Australian primary human papillomavirus (HPV) cervical screening program.

Materials and methods

A retrospective observational study of 4542 women seen at The Royal Women's Hospital Colposcopy Clinic in Melbourne, from 1 December 2017 to 31 July 2020 after a higher-risk cervical screening test (CST) result.

Results

Histological CIN2+ was detected in 25.1% up to two years from first colposcopy visit (FCV). The majority (86.7%) of CIN2+ was detected early within the first six months of presentation. Biopsy rate overall was 96.1% with abnormal colposcopic impression. Of four colposcopists with a lower biopsy rate, only one was able to achieve this early detection rate. Biopsy was also taken in over 30% of cases with negative reflex cytology and normal colposcopy, with CIN2+ detected in 5.0% among positive HPV16/18 and 3.8% with non-16/18 HPV. Positive predictive value of high-grade colposcopic impression at FCV averaged 66.4% (range: 54.9–81.6% among our colposcopists) and is poorly correlated with early detection rate of CIN2+. Overall accuracy of colposcopy is 84.5% (range: 78.7–90.3%), buoyed by high true negative colposcopic predictions secondary to high rates of negative reflex cytology referral with the new screening algorithm and is also unlikely to be a useful colposcopy indicator.

Conclusions

Early detection rate of CIN2+ within the first six months of presentation is a useful measure of colposcopy competency and we would encourage our National Cancer Screening Register to explore this with the participating colposcopists.

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来源期刊
CiteScore
3.40
自引率
11.80%
发文量
165
审稿时长
4-8 weeks
期刊介绍: The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.
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