Cervical cancer incidence after normal cytological sample in routine screening using SurePath, ThinPrep, and conventional cytology: population based study.
Cervical cancer incidence after normal cytological sample in routine screening using SurePath, ThinPrep, and conventional cytology: population based study.
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DOI：
10.1136/bmj.j504
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发表时间：
2017-02-14
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通讯作者：
van Ballegooijen M
中科院分区：
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作者：
Rozemeijer K;Naber SK;Penning C;Overbeek LI;Looman CW;de Kok IM;Matthijsse SM;Rebolj M;van Kemenade FJ;van Ballegooijen M
目的比较常规细胞学检查与液基细胞学检查SurePath和ThinPrep在正常筛查样本后72个月内诊断的宫颈癌累积发病率。 设计回顾性人群队列研究。 荷兰组织学和细胞病理学全国网络和登记处（PALGA），2000年1月至2013年3月。 妇女，5 924 474例正常筛查样本（23 833 123人年）。 暴露使用SurePath或ThinPrep与常规细胞学作为筛选试验。 主要结果测量每次筛查试验正常筛查样本后72个月浸润性宫颈癌的累积发病率。考克斯回归分析评估了风险比，调整了日历时间、年龄、筛查史和社会经济状况，并将实验室作为随机效应。 结果72个月累积癌症发病率为58.5（95%可信区间54.6 ~ 62.7）/10万正常常规细胞学样本，ThinPrep组为66.8（56.7 ~ 78.7）/10万正常常规细胞学样本，SurePath组为44.6（37.8 ~ 52.6）/10万正常常规细胞学样本。与传统细胞学检查相比，SurePath的浸润性癌症风险低19%（风险比0.81，95%置信区间0.66 - 0.99），主要是由于临床检测到的癌症风险低27%（0.73，0.57 - 0.93）。对于ThinPrep，风险平均高出15%（风险比1.15，0.95至1.38），主要是由于筛查检测到癌症的风险高出56%（1.56，1.17至2.08）。 结论这些发现应引起对不同类型液基细胞学和传统细胞学检测进行性宫颈上皮内瘤变敏感性相似性的重新考虑。
Objective To compare the cumulative incidence of cervical cancer diagnosed within 72 months after a normal screening sample between conventional cytology and liquid based cytology tests SurePath and ThinPrep. Design Retrospective population based cohort study. Setting Nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA), January 2000 to March 2013. Population Women with 5 924 474 normal screening samples (23 833 123 person years). Exposure Use of SurePath or ThinPrep versus conventional cytology as screening test. Main outcome measure 72 month cumulative incidence of invasive cervical cancer after a normal screening sample for each screening test. Cox regression analyses assessed the hazard ratios, adjusted for calendar time, age, screening history, and socioeconomic status and including laboratories as random effects. Results The 72 month cumulative cancer incidence was 58.5 (95% confidence interval 54.6 to 62.7) per 100 000 normal conventional cytology samples, compared with 66.8 (56.7 to 78.7) for ThinPrep and 44.6 (37.8 to 52.6) for SurePath. Compared with conventional cytology, the hazard of invasive cancer was 19% lower (hazard ratio 0.81, 95% confidence interval 0.66 to 0.99) for SurePath, mainly caused by a 27% lower hazard (0.73, 0.57 to 0.93) of a clinically detected cancer. For ThinPrep, the hazard was on average 15% higher (hazard ratio 1.15, 0.95 to 1.38), mainly caused by a 56% higher hazard of a screen detected cancer (1.56, 1.17 to 2.08). Conclusions These findings should provoke reconsideration of the assumed similarity in sensitivity to detect progressive cervical intraepithelial neoplasia between different types of liquid based cytology and conventional cytology.