子宫颈癌筛查方法研究现状和展望PPT参考课件.ppt

VILI 阴性 * VILI 阴性 * 典型的滴虫性宫颈炎表现为多发红点(“草莓样宫颈”). 卢戈氏碘液后的滴虫性宫颈炎所见 VILI 有助于诊断滴虫性阴道炎 * VILI 阳性 * VILI 阳性 * 可疑癌 * 肉眼观察的优点 VIA/ VILI 可望代替传统细胞学作为发展中国家 或资源不足地区的宫颈癌筛查方法 肉眼观察的设备简单、操作简便 即刻得到结果 可由经过培训的低年资医生操作 * 筛查方法 优 点 不 足 HPV DNA检测 + 液基细胞学 灵敏度98%，漏诊率低 费用太高(500元/例) 巴氏涂片 费用适中 假阴性率高，需要可靠细胞技术队伍 快速HPV检测 灵敏度较高90%，客观，费用适中,当时可知检查结果 还未商品化 VIA/VILI 费用低,易操作，当时可知检查结果，适合国情 费用低，政府能承受； 灵敏度低、主观性强、技术需要规范，每年开展以避免漏诊 几种筛查方法比较 * 展望（1） HPV疫苗上市后，是否仍需要宫颈癌筛查？ HPV疫苗只能覆盖70%（HPV16，18） 对已感染者无效 承受性和可接受性？ * 展望（2） 筛查中存在的问题 筛查方案及方法选择 培训与质控 筛查效果与很多因素有关，须统一标准和规范化检查 “即查即治”，“即筛即治”有待验证 * 展望（3） 快速HPV检测法 * Heater/shaker Denature Results displayed on LCD panel Luminometer Collect specimen Hybridize and capture Add probe and capture beads Detect Wash the beads FastHPV: schematic Heater/shaker Heater/shaker Conjugate Add substrate 30 min 40 min 30 min Heater/shaker 15 min 15 min Total time 2.5 hrs Transfer aliquot to single well ? 2006, Digene Corporation. All rights reserved * 中国医生学习预防宫颈癌的经验WHO训练班 * 推 荐 * 谢 谢！ * * * 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 test