MDHPVHPV检测临床关注的问题-培训课件.ppt

The first strategy that we will discuss is called “Cytology with reflex HPV”. This is a strategy that is used in many countries. The primary screen is with liquid based cytology. Women with negative Pap return for routine screening. Women with LSIL or greater are sent to colposcopy. Women with borderline cytology are tested for the presence of a high risk HPV genotype. If a woman has borderline cytology AND is HPV negative, she returns to routine screening. If a woman has borderline cytology AND is HPV positive, she is sent to colposcopy. In this strategy, there are only two options. Women are either sent for colposcopic evaluation or released until the next screening round. Some of the other strategies that will be explored have a third option- deferral. * 全球不同区域引起宫颈癌的排名前五位的HPV 亚型HPV16、18型感染率最高 Source: Clifford et al., 2003; British Journal of Cancer 88, 63 - 73 对来自世界各地的宫颈癌组织标本的研究发现，HPV16、18型感染率占到70% 中国宫颈癌及宫颈高度病变HPV亚型分布 中国宫颈癌HPV亚型分布： 2004-2006期间，中国各个区域共计1244例宫颈癌病例 ~85%的宫颈癌确诊病例是因为感染HPV16和18 % % % % % % % All Regions North Central North East North West South West East South HPV Type HPV Type % ~不同区域宫颈癌都是以感染HPV16和18为主 HPV亚型感染在不同区域的宫颈癌中无地域性差异 Chen w et al. HPV type-distribution in cervical cancer in China: the importance of HPV 16 and 18. Cancer Causes Control. 2009 Nov;20(9):1705-13. HPV16/18基因分型的意义 ACS/ASCCP/ASCP观点 HPV持续感染的女性有很大的危险发展为癌前病变 1～2年的HPV持续感染，特别是HPV16，在随后的几年极有可能被诊断为CIN3甚至更严重 HPV16持续感染1～2年有20%～30%的风险在5年之后诊断出CIN3+ Women whose infections persist are at significant risk of developing precancerous lesions. One-year and 2-year HPV persistence, especially by HPV16, strongly predict CIN3 or more severe diagnoses (CIN3t) in the subsequent years (eg, a 20%-30% risk of CIN3t over 5 years for one-year or 2-year persistent HPV16). 不同型别hrHPV阳性时≥CIN2 病变的10年累积发病率 Khan MJ, et al. J Natl Cancer Inst 2005; 97:1072–1079. * No histological evidence of cervical disease at baseline;95% confidence intervals are shown in parentheses. Follow-up time (months) Othe