用高风险人类乳头瘤病毒检测进行子宫癌查:美国预防服务工作组的最新证据报告和系统审查
Joy Melnikow1, Jillian T Henderson2, Brittany U Burda2
1University of California, Davis, Center for Healthcare Policy and Research, Sacramento.
JAMA
|August 25, 2018
概括
高危人乳头瘤病毒 (hrHPV) 查检测出更多的宫癌前细胞变化,但增加了假阳性. 与单独细胞检查相比,HPV查降低了侵袭性宫癌的风险.
科学领域:
- 妇科医生
- 癌症学
- 公共卫生
背景情况:
- 通过早期检测和治疗癌前变化可以预防宫癌.
- 高风险的人类乳头瘤病毒 (hrHPV) 导致90%以上的宫癌.
研究的目的:
- 系统地审查 hrHPV 查子宫癌的益处和危害.
- 为美国预防服务工作组准则提供信息.
主要方法:
- 随机临床试验和队列研究的系统审查.
- 在2011年至2018年期间搜索了MEDLINE,PubMed,PsycINFO和Cochrane图书馆.
- 来自8个RCT,5个队列研究和1个元分析的数据的定性综合.
主要成果:
- 与细胞检测相比,初级 hrHPV 查增加了 CIN 3+ 的检测.
- 随机检测没有显示初始CIN 3+检测增加,但降低了侵袭性宫癌的风险.
- 这两种HRHPV策略的假阳性率和胆囊镜检查率都高于细胞检查.
结论:
- 主要的HRHPV查有效检测癌前变化.
- 在 hrHPV 查中,假阳性率较高可能导致治疗增加和潜在的危害.
- 在减少侵袭性宫癌发病率方面,HPV查策略显得有前途.
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