Organisation of cervical cytology screening in Croatia: past, present and future.
Organisation of cervical cytology screening in Croatia: past, present and future.
复制标题
克罗地亚宫颈细胞学筛查的组织：过去、现在和未来。
作者：
M. Pajtler;S. Audy;I. Kardum‐Skelin;V. Mahovlić;Danijela Mozetic;A. Ovanin
本报告着重介绍了克罗地亚宫颈细胞学检查的优势和劣势，特别是机会性检查、传统巴氏试验的使用以及与之相关的一些组织、教育和绩效问题的分析，目的是提出措施，提高宫颈细胞学检查的效率，以降低宫颈癌死亡率。目前，分散在全国各地的35个实验室每年进行450 000多次巴氏试验。所有这些实验室都使用标准操作程序，包括内部和外部质量控制。他们总共雇用了68名细胞学家和91名细胞技术员。克罗地亚宫颈筛查的敏感性为90.0%，特异性为98.6%，阳性预测值为92.3%，阴性预测值为98.1%，总体诊断准确率为97.2%。宫颈细胞学的高诊断准确性归因于细胞学家（自1967年以来的研究生硕士课程，自1974年以来的独立居住）和细胞技术人员（自1968年以来）的长期教育和培训传统。这一跨越半个多世纪的传统意味着，今天在克罗地亚有一个发达的细胞学实验室网络，由高度胜任的细胞学家和训练有素的细胞技术专家组成。通过巴氏试验检测癌症的高准确性提供了强有力的证据，支持宫颈细胞学筛查仍然是预防宫颈癌的基本方法。然而，需要对目前的情况作一些修改。这些主要涉及机会性筛查。目前的筛查覆盖率为68%，尽管有能力让所有高危妇女，即25-64岁的妇女每三年接受一次筛查。检查范围主要涉及因不相关疾病而到妇科门诊诊所就诊的妇女。一个适当组织和控制的国家筛查方案应取代这一做法。同时还应采用其他高灵敏度的样本采集和制备方法，例如采用新技术，如液基细胞学。
This presentation highlights strengths and weaknesses of cervical cytology screening in Croatia, with particular reference to the opportunistic screening, the use of conventional Papanicolaou (Pap) test and the analysis of some organizational, educational and performance issues that are associated with it. Its aim is to propose measures to improve the efficacy of cervical cytology screening in order to reduce cervical cancer mortality. Currently, in excess of 450,000 Pap tests/ year are examined at 35 laboratories scattered throughout the country. All of these laboratories use standard operating procedures including internal and external quality control. They employ a total of 68 cytologists and 91 cytotechnologists. The sensitivity of cervical screening in Croatia is 90.0%, specificity 98.6%, positive predictive value 92.3%, negative predictive value 98.1% and overall diagnostic accuracy 97.2%. The high diagnostic accuracy of cervical cytology is attributed to the long-standing tradition of education and training of cytologists (postgraduate MSc course since 1967, independent residency since 1974) and cytotechnologists (since 1968). This tradition spanning more than half a century means that today in Croatia there is a developed network of cytology laboratories staffed by highly competent cytologists and trained cytotechnologists. The high accuracy of cancer detection through Pap tests provides strong evidence in support of cervical cytology screening remaining the basic method of prevention for cervical carcinoma. However, some modifications to the current situation are needed. These relate primarily to opportunistic screening. The current screening coverage rate is 68%, although there is capacity, which would allow for all women at risk, i.e. those aged 25-64, to be screened once in three years. The screening coverage relates mainly to those women visiting gynecological out patient clinics for unrelated conditions. A properly organized and controlled national screening programme should replace this. This should be accompanied by the introduction of alternative, highly sensitive methods of sample collection and preparation, such as are available through the introduction of new technologies, e.g. liquid based cytology.