宫颈癌筛查讲座课件.ppt

宫颈癌筛查方法宫颈涂片细胞学 传统巴氏涂片 1917 Papanicolaou 啮齿动物阴道细胞研究 1941年在美国妇产科杂志 阴道细胞学涂片 宫颈癌 1951年杨大旺先生引入我国 宫颈涂片：细胞学 传统方法: 优点 简便 无创 价廉 重复 获得远处标本：宫腔、输卵管等 缺点 假阴性 5-20% 误差原因 取样及制备: 取样器未取到细胞 细胞未被转移到载玻片上 固定不及时 读片: 炎细胞、杂质、血液、细胞重叠 细胞形态和结构不清晰 细胞学诊断技术进展 CCT: 计算机辅助宫颈细胞学诊断系统（computer-assisted cytologic test ） 人工智能电脑自动分析扫描系统 取材、制片方法无改进 优点: 减轻视觉疲劳造成的误诊， 提高准确性和工作效率。 传统涂片：只转移了取样器上约20%细胞，80%细胞被丢弃 HPV感染与宫颈癌 宫颈癌致病原因 HPV(Human papillomavirus) DNA病毒 嗜上皮病毒 1977年 Laverty 电镜 宫颈癌标本 HPV颗粒 分组 按致癌危险性 高危型：16，18，31，33，35… 低危型：6，11… 病毒负荷增加，癌危险性增加 癌前病变检出高危型HPVDNA， 发展至癌危险性增加 HPV感染 全世界十分普遍 正常妇女感染率 5-44% HPV感染↑ 随诊3年 70%妇女 青少年最常见 80%患者17-33岁 高峰发病年龄 20-24岁 我国 70年代尖锐湿疣发病率快速增长 生殖器最常见病毒性性传播疾病 性传播疾病位居第二 Greater Sensitivity for Detecting HSIL Hybrid Capture? 2 HPV DNA Test Cervical Sampler? * 中国妇产科资料网 * 中国妇产科资料网 The results are interesting: As you can see, the sensitivity of the HPV test was superior to that of the Pap test. The HPV test had a sensitivity of 89.2% for detection of HSIL versus the Pap’s sensitivity of 76.2%. Researchers estimated “that an HPV based algorithm including the immediate colposcopy of HPV-positive women, and then repeat Pap testing of all others, would provide an overall sensitivity of 96.9%”.10 Furthermore, the HPV test identified 100% of all women with HSIL who had an AGUS smear, whereas repeat Pap smears identified only 57% of HSIL in women who had an AGUS smear. Employing reflex HPV testing, the referral to colposcopy was reduced to 38%, representing a 62% reduction compared to colposcoping all women with ASCUS. The specificity of the repeat Pap smear was about the same as the specificity of the HPV test. With superior sensitivity and comparable specificity, clearly HPV testing is th