Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update.
Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update.
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DOI：
10.1200/go.22.00217
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发表时间：
2022-09
影响因子：
4.5
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中科院分区：
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更新全球宫颈癌二级预防的资源分层、循证建议。美国临床肿瘤学会召集了一个多学科、跨国专家小组，提出了反映四种资源分层环境的建议。对现有指南、基于共识的正式流程以及修改后的 ADAPTE 流程进行了审查，以适应现有指南。其他专家参与形成正式共识。本指南更新反映了自上次更新以来证据的变化。确定并审查了五项现有指南，并根据证据基础提出了调整后的建议。成本效益分析提供了达成共识的间接证据，达成了 ≥ 75% 的共识。建议在所有资源环境中进行人乳头瘤病毒 (HPV) DNA 检测；可以在基本设置中使用乙酸目视检查。建议的年龄范围和频率因以下设置而异： 最大：年龄 25-65 岁，每 5 年一次；加强：年龄30-65岁，如果间隔5年连续两次检测呈阴性，则每10年一次；限定：年龄30-49岁，每10年一次；基本：年龄30-49岁，一生1-3次。对于基本设置，视觉评估用于确定治疗资格；在其他情况下，使用细胞学或单独细胞学进行基因分型来确定治疗。对于基本情况，如果分诊结果异常，建议进行治疗；在其他情况下，建议在分诊结果异常后进行阴道镜检查。对于基本设置，治疗选项是热消融或环形电外科切除手术；对于其他情况，建议进行环形电外科切除手术或消融；在所有情况下进行 12 个月的随访。 HIV 呈阳性的女性在诊断后应接受 HPV 检测，一生中的次数是一般人群的两倍。建议在基本情况下于产后 6 周进行筛查；在其他情况下，建议在 6 个月大时进行筛查。在没有大规模筛查的基础设施中，应开发 HPV 检测、诊断和治疗的基础设施。更多信息请访问 www.asco.org/resource-stratified-guidelines。
To update resource-stratified, evidence-based recommendations on secondary prevention of cervical cancer globally. American Society of Clinical Oncology convened a multidisciplinary, multinational Expert Panel to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, formal consensus-based process, and modified ADAPTE process to adapt existing guidelines was conducted. Other experts participated in formal consensus. This guideline update reflects changes in evidence since the previous update. Five existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies vary by the following setting: maximal: age 25-65 years, every 5 years; enhanced: age 30-65 years, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: age 30-49 years, every 10 years; basic: age 30-49 years, one to three times per lifetime. For basic settings, visual assessment is used to determine treatment eligibility; in other settings, genotyping with cytology or cytology alone is used to determine treatment. For basic settings, treatment is recommended if abnormal triage results are obtained; in other settings, abnormal triage results followed by colposcopy is recommended. For basic settings, treatment options are thermal ablation or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure or ablation is recommended; with a 12-month follow-up in all settings. Women who are HIV-positive should be screened with HPV testing after diagnosis, twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed. Additional information is available at www.asco.org/resource-stratified-guidelines.