2019 ASCCP Risk-Based Management Consensus Guidelines: Methods for Risk Estimation, Recommended Management, and Validation
2019 ASCCP Risk-Based Management Consensus Guidelines: Methods for Risk Estimation, Recommended Management, and Validation
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DOI：
10.1097/lgt.0000000000000528
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发表时间：
2020-04-01
影响因子：
3.7
通讯作者：
Schiffman, Mark
中科院分区：
文献类型：
--
作者：
Cheung, Li C.;Egemen, Didem;Schiffman, Mark
目的为了管理宫颈筛查异常，2019 年 ASCCP 管理共识指南将根据宫颈癌前病变和癌症的风险推荐临床行动。本文详细介绍了用于估计风险、确定基于风险的管理以及验证基于风险的建议在不同环境中通用的方法。方法基于 2003 年至 2017 年在北加州凯撒医疗机构通过联合检测进行三年一次宫颈筛查的 150 万名患者，我们评估了不同临床情况以及过去和当前人乳头瘤病毒和细胞学检测结果组合的风险概况。我们通过与几个外部数据源中的估计风险进行比较来验证推荐的管理方法。结果 Egemen 等人(1) 和 Demarco 等人(2) 分别提出了风险和管理表。来自北加州 Kaiser Permanente 的基于风险的管理基本上与其他数据源估计风险所隐含的管理一致。结论 新的基于风险的指南提出了异常宫颈筛查结果的管理。通过描述用于制定这些指南的步骤，本文中提出的方法可以为基于风险的指南的未来扩展提供基础。
ObjectiveTo manage cervical screening abnormalities, the 2019 ASCCP management consensus guidelines will recommend clinical action on the basis of risk of cervical precancer and cancer. This article details the methods used to estimate risk, to determine the risk-based management, and to validate that the risk-based recommendations are of general use in different settings. MethodsBased on 1.5 million patients undergoing triennial cervical screening by cotesting at the Kaiser Permanente Northern California from 2003 to 2017, we estimated risk profiles for different clinical scenarios and combinations of past and current human papillomavirus and cytology test results. We validated the recommended management by comparing with the estimated risks in several external data sources. ResultsRisk and management tables are presented separately by Egemen et al.(1) and Demarco et al.(2) Risk-based management derived from the Kaiser Permanente Northern California largely agreed with the management implied from the estimated risks of the other data sources. ConclusionsThe new risk-based guidelines present management of abnormal cervical screening results. By describing the steps used to develop these guidelines, the methods presented in this article can provide a basis for future extensions of the risk-based guidelines.