2015年美国宫颈癌筛查过渡期临床指南

/201511346JIntReprodHealth蛐FamPlanNovember2015,Vol.34,No.6··《2015》【】HPV。HPV。《2015》HPVHPV。、。【】Interpretationof2015InterimClinicalGuidanceforAmericanCervicalCancerScreeningWANGBao-chen，XUEFeng-xia.DepartmentofObstetricsandGynecology，TianjinMedicalUniversityGeneralHospital，Tianjin300052，China【Abstract】Cervicalcancerisanimportantdiseaseburdenofwomenintheworld.Thepersistentinfectionofhigh-riskHPV（HR-HPV）isoneofmajorfactorsofcervicalcancer.Atpresent，themajormethodsofcervicalcancerscreeningintheUnitedStatesarethecervicalcytologytestingandtheco-screeningwithcytologyandHR-HPVtesting.HR-HPVtestingalonecouldbeoneoftheprimaryscreeningmethodsforcervicalcancer,whichisproposedbythe2015AmericanInterimClinicalGuidance.HR-HPVtestingalonecouldbeaalternativestrategyforthecytologytestingandtheco-screening.Wehereininterpretthebackground，maincontentandevidenceofthisguidance.【Keywords】Uterinecervicalneoplasms；Papillomaviridae；Cytodiagnosis；Guidebooks（JIntReprodHealth蛐FamPlan，201534495-498）2012WHO52.826.687%6.23[1]。、。11943。theBethesdasystemTBS。HPV、HPV、。2006AmericanSocietyofColposcopyandCervicalPathologyASCCP[2]HPV30。HPVHPVHPV。HPVASCUS。2001ASCCP[3]HPVASCUS。HPV。2011AmericanCancerSocietyASC、ASCCPAmericanSocietyforClinicalPathologyASCP[4]HPV。HPVHPVHPVHPV。30HPV。HPVATHENAAddressingtheNeedforAdvancedHPVDiagnostics[5]HPVHPV。300052E-mail:[e-mail]495··/201511346JIntReprodHealth蛐FamPlanNovember2015,Vol.34,No.6SocietyofGynecologicOncologySGOASCCP713《2015》[6]。25HPVCobas4800HPVHPV。HPVHPVHPV161812HPVHPV313335394551525658596668ASCUS12。2011①②CIN+CIN+③。HPVHPV。HPVHPV。HPV。22.1HPVHPV3CIN+。2008EuropeanResearchOrganizationonGenitalInfectionandNeoplasiaEUROGINHPV[7]。Dillner[8]67HPV242956GP5+/6+PCRHPV2HC23CIN+HPVCIN+350.12%vs.0.51%0.25%vs.0.83%。Ronco[9]4HPVNTCC、ARTISTIC、SwedescreenPOBASCAMDillner[8]。417.6HPVHC2PCR。2.5HPV3.55.50.0046%vs.0.0154%0.0087%vs.0.0360%。。Gage[10]KPNCKaiserPermanenteNorthernCalifornia100HPV30～64102003—2012HPVHC2HPV3CIN+0.07%vs.0.19%50.14%vs.0.31%。HPV。ATHENA[5]HPV120083。HPV3CIN+0.34%vs.0.78%。HPVCIN+50%CIN+。HPVCIN+HPV。2.2HPVHPVHPV。HPVHPV、。HPV、HPV16/18、HPV16/18/31/33/45p16。VUSA-Screen30～602.51303HC2HPVHPVCIN+。HPV70%HPV16/1850%。HPV16/18[11]。VUSA-ScreenHPV1021p16/Ki-67[12]HPV16/18p16/Ki67CIN+73.3%vs.46.7%。HPVCIN+56.9%p16/Ki-67CIN+5HPV16/183.3%3.6%。p16/Ki-67HPV496··/201511346JIntReprodHealth蛐FamPlanNovember2015,Vol.34,No.6HPV。《2015》HPVHPV16/18。HPV16/1812HPV。ATHENAHPV16/18CIN+321.16%12HPV5.4%。VUSA-Screen。HPV、HPVHPV。CIN+、CIN+、CIN+HPVHPV16/1812HPV。HPV[13]CIN+25%vs.90%。HPVHPV。2.3HPVHPVCIN+HPVCIN+。35。HPV。ATHENA3CIN+1%3CIN+3HPV3。、HPV3[9]。5VUSA-ScreenHC2197945CIN+0.09%[14]。HPV1252732～38HPVGP5+/6+13CIN+0.89%[15]。KPNC31HC25CIN+0.17%0.0038%[16]。HPV。2.4HPVHPV25。2130。ATHENA30%CIN+25～2937%30～3925～29CIN+。HPV25301CIN+54%。25。CIN+25～2930。2.5HPVHPVKPNC[16]10030～64504.3HPV35CIN+CIN+0.069%vs.0.11%P0.000131HPV51。HPVHPV55HPVKPNC。HPV5CIN+0.14%vs.0.11%51HPV1/3～1/2。31HPV51HPV。3HPVHPV[17]。HPVHPVHPV。99.7%HPV[1]。HPV10%[18]。682SPF10PCRHPVHPV37.2%HPV28.2%115HPV81.7%[19]。HPV。ATHENACobas4800HPVCIN+58.6%FDA。FDAHPV。HPV。《2015》HPVHPVCobas4800HPVHPVHPVHPV。、、497··/201511346JIntReprodHealth蛐FamPlanNovember2015,Vol.34,No.6HPVHPV。、。[1]InternationalAgencyforResearchonCancer.Globacan2012database[R].LyonIARC2013.[2]WrightTCJrMassadLSDuntonCJetal.2006consensusguidelinesforthemanagementofwomenwithabnormalcervicalscreeningtests[J].JLowGenitTractDis2007114201-222.[3]WrightTCJrCoxJTMassadLSetal.2001ConsensusGuidelinesforthemanagementofwomenwithcervicalcytologicalabnormalities[J].JAMA2002287162120-2129.[4]SaslowDSolomonDLawsonHWetal.AmericanCancerSocietyAmericanSocietyforColposcopyandCervicalPathologyandAmericanSocietyforClinicalPathologyscreeningguidelinesforthepreventionandearlydetectionofcervicalcancer[J].AmJClinPathol20121374516-542.[5]WrightTCStolerMHBehrensCMetal.PrimarycervicalcancerscreeningwithhumanpapillomavirusendofstudyresultsfromtheATHENAstudyusingHPVasthefirst-linescreeningtest[J].GynecolOncol20151362189-197.[6]HuhWKAultKAChelmowDetal.Useofprimaryhigh-riskhumanpapillomavirustestingforcervicalcancerscreeninginterimclinicalguidance[J].GynecolOncol20151362178-182.[7]FranceschiSCuzickJHerreroRetal.EUROGIN2008roadmaponcervicalcancerprevention[J].IntJCancer2009125102246-2255.[8]DillnerJReboljMBirembautPetal.LongtermpredictivevaluesofcytologyandhumanpapillomavirustestingincervicalcancerscreeningjointEuropeancohortstudy[J].BMJ2008337a1754.[9]RoncoGDillnerJElfstr觟mKMetal.EfficacyofHPV-basedscreeningforpreventionofinvasivecervicalcancerfollow-upoffourEuropeanrandomisedcontrolledtrials[J].Lancet20143839916524-532.[10]GageJSchiffmanMKatkiHAetal.Reassuranceagainstfutureriskofprecancerandcancerconferredbyanegativehumanpapillomavirustest[J].JNatlCancerInst20141068.piidju153.[11]RijkaartDCBerkhofJvanKemenadeFJetal.Evaluationof14triagestrategiesforHPVDNA-positivewomeninpopulation-basedcervicalscreening[J].IntJCancer20121303602-610.[12]UijterwaalMHPolmanNJWitteBIetal.TriagingHPV-positivewomenwithnormalcytologybyp16/Ki-67dual-stainedcytologytestingbaselineandlongitudinaldata[J].I