切换至 "中华医学电子期刊资源库"

中华妇幼临床医学杂志(电子版) ›› 2024, Vol. 20 ›› Issue (05) : 575 -581. doi: 10.3877/cma.j.issn.1673-5250.2024.05.015

专题论坛

不同筛查方法预警宫颈原位腺癌的效能
石皆春1, 范子玉1, 邢燕1,()   
  1. 1.南京医科大学第一附属医院妇科,南京 210029
  • 收稿日期:2024-02-03 修回日期:2024-07-24 出版日期:2024-10-01
  • 通信作者: 邢燕
  • 基金资助:
    江苏省卫健委卫生发展研究中心公开基金资助项目(JSHD2022024)江苏省妇幼健康研究会资助项目(JSFY202108)

Early warning efficiency of different screening methods on cervical adenocarcinoma in situ

Jiechun Shi1, Ziyu Fan1, Yan Xing1,()   

  1. 1.Department of Gynecology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,Jiangsu Province,China
  • Received:2024-02-03 Revised:2024-07-24 Published:2024-10-01
  • Corresponding author: Yan Xing
引用本文:

石皆春, 范子玉, 邢燕. 不同筛查方法预警宫颈原位腺癌的效能[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 575-581.

Jiechun Shi, Ziyu Fan, Yan Xing. Early warning efficiency of different screening methods on cervical adenocarcinoma in situ[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 575-581.

宫颈原位腺癌(AIS)为宫颈腺癌(CA)的癌前病变,进展为浸润癌的风险高。由于宫颈AIS临床表现不典型、病灶隐匿,对宫颈癌的现有筛查方法不敏感,因此临床对宫颈AIS患者的早期发现及诊断存在一定困难和挑战。目前,国内外普遍采用宫颈脱落细胞学检查,即宫颈液基薄层细胞学检测(TCT)联合高危型人乳头状瘤病毒(HPV)初筛+阴道镜检查+组织病理学检查的“3阶梯”宫颈病变诊断模式,其中宫颈TCT 联合高危型HPV 初筛逐渐过渡为高危型HPV 初筛。一些宫颈癌筛查新技术,如宫颈脱落细胞DNA 倍体分析、p16/Ki-67双染也逐渐被应用于临床。随着医工融合领域兴起,计算机辅助诊断和图像识别技术在宫颈癌筛查中的应用,也在进一步研究发展中。笔者拟就不同筛查方法预警宫颈AIS效能的最新研究现状进行阐述。

Cervical adenocarcinoma insitu (AIS),as a precancerous lesion of cervical adenocarcinoma(CA),has a high risk of progressing to invasive cancer.Due to the atypical clinical manifestations,insidious lesions and the insensitivity of existing cervical cancer screening methods,there are certain difficulties and challenges in the early detection and diagnosis of AIS.At present,the"3-step"cervical lesion diagnosis ThinPrep liquid-based cytology test(TCT)combined with high-risk human papillomavirus(HPV)preliminary screening+colposcopy+histopathology is generally adopted at home and abroad,in which TCT combined with high-risk HPV preliminary screening gradually transitions to high-risk HPV preliminary screening.Some new techniques of cervical cancer screening,such as DNA ploidy a nalysis and p16/Ki-67 double staining of cervical exfoliated cells,have been gradually applied in clinical practice.With the rise of medical and industrial integration,the application of computer-aided diagnosis and image recognition technology in cervical cancer screening is also being further studied and developed.This article elaborates on the latest research status on early warning efficacy of different screening methods on cervical AIS.

[1]
马敏榕, 李聪, 周勤.宫颈癌治疗研究现状[J/OL].中华妇幼临床医学杂志(电子版),2023,19(5):497-504.DOI:10.3877/cma.j.issn.1673-5250.2023.05.001.Ma MR,Li C,Zhou Q.Current research status of treatment of cervical cancer[J/OL].Chin J Obstet Gynecol Pediatr(Electron Ed),2023,19(5):497-504.DOI:10.3877/cma.j.issn.1673-5250.2023.05.001.
[2]
Cleveland AA,Gargano JW,Park IU,et al.Cervical adenocarcinoma insitu:human papillomavirus types and incidence trends in five states,2008-2015[J].Int J Cancer,2020,146(3):810-818.DOI:10.1002/ijc.32340.
[3]
Khan MYA,Bandyopadhyay S,Alrajjal A,et al.Atypical glandular cells (AGC):cytology of glandular lesions of the uterine cervix[J].Cytojournal,2022,19:31.DOI:10.25259/CMAS_03_11_2021.
[4]
Bruno MT,Valenti G,Cassaro N,et al.The coexistence of cervical intraepithelial neoplasia (CIN3)and adenocarcinoma insitu(AIS)in LEEP excisions performed for CIN3[J].Cancers,2024,16 (5):847.DOI:10.3390/cancers16050847.
[5]
Davey DD,Souers RJ,Goodrich K,et al.Bethesda 2014 implementation and human papillomavirus primary screening:practices of laboratories participating in the College of American Pathologists PAP Education Program[J].Arch Pathol Lab Med,2019,143(10):1196-1202.DOI:10.5858/arpa.2018-0603-CP.
[6]
马德勇, 冯慧, 贺丹, 等.子宫颈细胞学非典型腺细胞临床价值分析[J].中国实用妇科与产科杂志,2022,38(3):331-335.DOI:10.19538/j.fk2022030117.Ma DY,Feng H,He D,et al.Clinical value analysis of atypical glandular cells in cervical cytology[J].Chin J Pract Gynecol Obstet,2022,38(3):331-335.DOI:10.19538/j.fk2022030117.
[7]
Yucel Polat A,Tepeoglu M,Tunca MZ,et al.Atypical glandular cells in papanicolaou test:which is more important in the detection of malignancy,architectural or nuclear features? [J].Cytopathology,2021,32(3):344-352.DOI:10.1111/cyt.12957.
[8]
Wang T,Hua Y,Liu L,et al.Analysis of atypical glandular cells in thinprep pap smear and follow-up histopathology[J].Proc (Bayl Univ Med Cent),2024,37(3):403-407.DOI:10.1080/08998280.2024.2324656.
[9]
Niu S,Molberg K,Thibodeaux J,et al.Challenges in the pap diagnosis of endocervical adenocarcinoma insitu[J].J Am Soc Cytopathol,2019,8(3):141-148.DOI:10.1016/j.jasc.2018.12.004.
[10]
Toyoda S,Kawaguchi R,Kobayashi H.Clinicopathological characteristics of atypical glandular cells determined by cervical cytology in Japan:survey of gynecologic oncology data from the Obstetrical Gynecological Society of Kinki District,Japan[J].Acta Cytol,2019,63(5):361-370.DOI:10.1159/000498977.
[11]
Al-Rayyan E,Rashed M,Maaita M,et al.The incidence and clinical significance of atypical glandular cells of undetermined significance on cervical pap smears[J].Gulf J Oncolog,2019,1(30):52-56.
[12]
Pulkkinen J,Huhtala H,KholováI.False-positive atypical endocervical cells in conventional pap smears:cytohistological correlation and analysis[J].Acta Cytol,2023,67(6):604-617.DOI:10.1159/000533256.
[13]
Aytekin O,Cakir C,Unsal M,et al.Clinicopathological features of atypical glandular cells,not otherwise specified,on cervicovaginal pap s mears[J].Cytopathology,2023,34(2):130-137.DOI:10.1111/cyt.13204.
[14]
Hassan D,Findley J,Braun A,et al.Cytology-histology correlation of atypical glandular cells on cervical pap tests:a study of 628 cases[J].J Am Soc Cytopathol,2024,13(5):377-385.DOI:10.1016/j.jasc.2024.05.002.
[15]
Lin M,Narkcham S,Jones A,et al.False-negative Papanicolaou tests in women with biopsy-proven invasive endocervical adenocarcinoma/adenocarcinoma insitu:a retrospective analysis with assessment of interobserver agreement[J].J Am Soc Cytopathol,2022,11(1):3-12.DOI:10.1016/j.jasc.2021.08.001.
[16]
Srisomboon S,Tantipalakorn C,Charoenkwan K,et al.Cervical screening results leading to detection of adenocarcinoma insitu of the uterine cervix[J].Asian Pac J Cancer Prev,2019,20(2):377-382.DOI:10.31557/APJCP.2019.20.2.377.
[17]
刘语橦.92例宫颈原位腺癌临床特征分析[D].青岛: 青岛大学,2022.DOI:10.27262/d.cnki.gqdau.2022.001853.Liu YT.Clinical characteristics of 92 cases with adenocarcinoma insitu of cervix[D].Qingdao:Qingdao University,2022.DOI:10.27262/d.cnki.gqdau.2022.001853.
[18]
Bel Haj Rhouma R,Ardhaoui M,El Fehri E,et al.Distribution of human papillomavirus in precancerous and cancerous cervical neoplasia in Tunisian women[J].Infect Agent Cancer,2021,16(1):52.DOI:10.1186/s13027-021-00392-1.
[19]
金俊, 罗荣奎, 赵婧, 等.宫颈原位腺癌人乳头状瘤病毒感染情况及分型分析[J].中华病理学杂志,2022,51(4):338-343.DOI:10.3760/cma.j.cn112151-20210817-00578.Jin J,Luo RK,Zhao J,et al.Prevalence and frequencies of human papilloma virus types in adenocarcinoma insitu of the uterine cervix[J].Chin J Pathol,2022,51(4):338-343.DOI:10.3760/cma.j.cn112151-20210817-00578.
[20]
叶蕾, 石海燕, 姚晔丽, 等.TCT 和高危型HPV 检测在子宫颈原位腺癌诊断中的临床价值[J].中华妇产科杂志,2021,56(3):212-215.DOI:10.3760/cma.j.cn112141-20200903-00690.Ye L,Shi HY,Yao YL,et al.The clinical value of TCT and high-risk HPV detection in the diagnosis of adenocarcinoma of the cervix insitu[J].Chin J Obstet Gynecol,2021,56(3):212-215.DOI:10.3760/cma.j.cn112141-20200903-00690.
[21]
Song T,Seong SJ,Lee SK,et al.Searching for an ideal cervical cancer screening model to reduce false-negative errors in a country with high prevalence of cervical cancer[J].J Obstet Gynaecol,2020,40(2):240-246.DOI:10.1080/01443615.2019.1621813.
[22]
Giorgi Rossi P,Carozzi F,Ronco G,et al.P16/ki67 and E6/E7 m RNA accuracy and prognostic value in triaging HPV DNA-positive women[J].J Natl Cancer Inst,2021,113(3):292-300.DOI:10.1093/jnci/djaa105.
[23]
Tian R,Huang Z,Li L,et al.HPV integration generates a cellular super-enhancer which functions as ecDNA to regulate genome-wide transcription[J].Nucleic Acids Res,2023,51(9):4237-4251.DOI:10.1093/nar/gkad105.
[24]
Schiffman M,Mirabello L,Egemen D,et al.The combined finding of HPV 16,18,or 45 and cytologic atypical glandular cells(AGC)indicates a greatly e levated risk of insitu and invasive cervical adenocarcinoma[J].Gynecol Oncol,2023,174:253-261.DOI:10.1016/j.ygyno.2023.05.011..
[25]
Zhang RC,Vue NC,Obasi LU,et al.Impact of screening modality on the detection of cervical adenocarcinoma insitu and adenocarcinoma[J].J Low Genit Tract Dis,2021,25(4):267-269.DOI:10.1097/LGT.0000000000000618.
[26]
Barbara A,Gregory B,Mark S.Colposcopy:principles and practice[M].2nd ed.Philadelphia:Saunders,an Imprint of Elsevier Inc,2008:283-304.
[27]
McGee AE,Alibegashvili T,Elfgren K,et al.European consensus statement on expert colposcopy[J].Eur J Obstet Gynecol Reprod Biol,2023,290:27-37.DOI:10.1016/j.ejogrb.2023.08.369.
[28]
Ciavattini A,Giannella L,Delli Carpini G,et al.Adenocarcinoma insitu of the uterine cervix:clinical practice guidelines from the Italian Society of Colposcopy and Cervical Pathology (SICPCV)[J].Eur J Obstet Gynecol Reprod Biol,2019,240:273-277.DOI:10.1016/j.ejogrb.2019.07.014.
[29]
Lashmanova N,Braun A,Cheng L,et al.Endocervical adenocarcinoma insitu—from Papanicolaou test to hysterectomy:a series of 74 cases[J].J Am Soc Cytopathol,2022,11(1):13-20.DOI:10.1016/j.jasc.2021.08.002.
[30]
Qin Y,Deng J,Ling Y,et al.Our experience diagnosing 225 patients with cervical glandular lesions:current technologies,lessons learned,and areas for improvement[J].Diagn Pathol,2024,19(1):22.DOI:10.1186/s13000-023-01428-3.
[31]
李霞, 何跃东.宫颈DNA 倍体分析联合宫颈细胞学检查在宫颈癌筛查中的应用价值 [J/OL].中华妇幼临床医学杂志(电子版),2018,14(5):602-607.DOI:10.3877/cma.j.issn.1673-5250.2018.05.018.Li X,He YD.Screening values of cervical DNA ploidy analysis combined with cervical cytology test for cervical cancer[J/OL].Chin J Obstet Gynecol Pediatr (Electron Ed),2018,14(5):602-607.DOI:10.3877/cma.j.issn.1673-5250.2018.05.018.
[32]
高燕, 杨红, 张晓红, 等.人乳头瘤病毒、液基薄层细胞学及DNA 倍体联合筛查在宫颈癌患者诊断的临床价值[J].实用医院临床杂志,2021,18(6):36-38.DOI:10.3969/j.issn.1672-6170.2021.06.011.Gao Y,Yang H,Zhang XH,et al.The clinical value of joint screening of HPV,TCT and DNA ploidy in the diagnosis of cervical cancer[J].Pract J Clin Med,2021,18(6):36-38.DOI:10.3969/j.issn.1672-6170.2021.06.011.
[33]
Costa AF,Ribeiro MGM,Onofre ASC,et al.Aneuploidy detection for diagnostic and prognostic use in premalignant and malignant lesions of the uterine cervix:a systematic review[J].Diagn Cytopathol,2021,49(2):335-346.DOI:10.1002/dc.24683.
[34]
廖光东, 康乐妮, 李静, 等.p16/微小染色体维持蛋白2和p16/Ki-67双重染色对高危型人乳头瘤病毒呈阳性妇女的宫颈病变筛查 [J/OL].中华妇幼临床医学杂志(电子版),2017,13(4):425-431.DOI:10.3877/cma.j.issn.1673-5250.2017.04.010.Liao GD,Kang LN,Li J,et al.P16/minichromosome maintenance protein 2 and p16/Ki-67 double staining in cervical lesions screening of high-risk human papillomavirus positive women[J/OL].Chin J Obstet Gynecol Pediatr(Electron Ed),2017,13(4):425-431.DOI:10.3877/cma.j.issn.1673-5250.2017.04.010.
[35]
方钦,Soul Hassanati, 房园园, 等.P16/Ki-67对宫颈细胞学正常的高危型HPV 阳性患者预后的价值[J].南京医科大学学报(自然科学版),2020,40(12):1768-1773.DOI:10.7655/NYDXBNS20201205.Fang Q,Hassanati S,Fang YY,et al.Predictive value of p16/Ki-67 in high-risk HPV-positive patients with negative cytology[J].J Nanjing Med Univ (Natural Sci Ed),2020,40(12):1768-1773.DOI:10.7655/NYDXBNS20201205.
[36]
李雪, 石中月, 杨志明, 等.人工智能辅助分析在宫颈液基薄层细胞学检查中的应用价值[J].首都医科大学学报,2020,41(3):360-363.DOI:10.3969/j.issn.1006-7795.2020.03.008.Li X,Shi ZY,Yang ZM,et al.Value about artificial intelligence-assisted liquid-based thin-layer cytology for cytology cervical cancer screening[J].J Capital Med Univ,2020,41(3):360-363.DOI:10.3969/j.issn.1006-7795.2020.03.008.
[37]
刘畅, 郑宇超, 谢文倩, 等.基于深度学习的宫颈原位腺癌图像识别方法[J].协和医学杂志,2023,14(1):159-167.DOI:10.12290/xhyxzz.2022-0109.Liu C,Zheng YC,Xie WQ,et al.Image recognition method of cervical adenocarcinoma insitu based on deep learning[J].Med J Peking Union Med College Hosp,2023,14(1):159-167.DOI:10.12290/xhyxzz.2022-0109.
[38]
Ren C,Zeng X,Shi Z,et al.Multi-center clinical study using optical coherence tomography for evaluation of cervical lesions in-vivo[J].Sci Rep,2021,11(1):7507.DOI:10.1038/s41598-021-86711-3.
[1] 汪洪斌, 张红霞, 何文, 杜丽娟, 程令刚, 张雨康, 张萌. 低级别阑尾黏液性肿瘤与阑尾黏液腺癌超声及超声造影特征分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 865-871.
[2] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 571-579.
[3] 刘伟, 牛云峰, 安杰. LINC01232 通过miR-516a-5p/BCL9 轴促进三阴性乳腺癌的恶性进展[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 330-338.
[4] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[5] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[6] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[7] 白浪, 张雪玉, 白铁成, 贺爱军. 腹腔镜近端胃切除术中圆锥形重叠吻合成形术对Siewert Ⅱ型AEG患者胃食管反流、营养状态的影响研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 679-682.
[8] 李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[9] 祝炜安, 林华慧, 吴建杰, 黄炯煅, 吴婷婷, 赖文杰. RDM1通过CDK4促进前列腺癌细胞进展的研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 618-625.
[10] 王功炜, 李书豪, 魏松, 吕博然, 胡成. 溶瘤病毒M1对不同前列腺癌细胞杀伤效果的研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 626-632.
[11] 刘琦, 王守凯, 王帅, 苏雨晴, 马壮, 陈海军, 司丕蕾. 乳腺癌肿瘤内微生物组的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 841-845.
[12] 崔军威, 蔡华丽, 胡艺冰, 胡慧. 亚甲蓝联合金属定位夹及定位钩针标记在乳腺癌辅助化疗后评估腋窝转移淋巴结的临床应用价值探究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 625-632.
[13] 杨菲, 刘腾飞, 赵志军, 李睿聪, 张颉, 刘妍, 赵珍. 血清维生素水平与分化型甲状腺癌的关联性研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 633-640.
[14] 王誉英, 刘世伟, 王睿, 曾娅玲, 涂禧慧, 张蒲蓉. 老年乳腺癌新辅助治疗病理完全缓解的预测因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 641-646.
[15] 王帅, 张志远, 苏雨晴, 李雯雯, 王守凯, 刘琦, 李文涛. 孟德尔随机化及其在乳腺癌研究中的应用进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 671-676.
阅读次数
全文


摘要