Liquid-based cytology: evaluation of effectiveness, cost-effectiveness, and application to present practice.
Liquid-based cytology: evaluation of effectiveness, cost-effectiveness, and application to present practice.
复制标题
液基细胞学：有效性、成本效益评估以及在当前实践中的应用。
DOI：
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
J. Thomas Cox
中科院分区：
文献类型：
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作者：
J. Thomas Cox
本文回顾了截至2004年的有效性和成本效益的宫颈筛查与两种可用的细胞学方法，传统的巴氏涂片（巴氏; CP）和液基细胞学（LBC）的数据，并讨论了LBC的应用到目前的做法。大多数LBC研究都是关于ThinPrep Pap Test的（CYTYC，Boxsborough，MA），其余的在SurePath上（TriPath，Burlington，NC），与配对的常规细胞学检查相比，LBC在21例ThinPrep中的17例和12例SurePath“分裂样本”中的9例中发现了更多的低度鳞状上皮内病变（LSIL）巴氏试验结果。被认为符合英国NHS健康技术评估（HTA）宫颈细胞学评价标准的研究。在最近6项ThinPrep研究中的4项和2项SurePath分离样本研究中的1项中，LBC比CP识别出更多的高度鳞状上皮内病变阳性（HSIL+）结果。与CP相比，所有15项符合HTA标准的“直接进瓶研究”报告了更多的LBC LSIL+结果，所有8项分别报告HSIL+结果的直接进瓶研究均显示高级别细胞学解释的检出率增加。15项研究符合敏感性和特异性评价标准。CP的总敏感性为71.5%，LBC为80.1%。两种LBC方法的间接比较没有发现灵敏度的差异，对比较CP和LBC之间特异性的6项研究的荟萃分析也没有发现差异。LBC的其他功能是提高样本充足性和从液基小瓶中进行辅助检测的能力。在基于疾病自然史模型和/或每种筛查方式的临床有效性的成本效益分析中，CP筛查总是以LBC筛查为主。美国癌症协会在2002年发布的初级宫颈筛查指南建议，如果是基于液体的，则每半年重复一次细胞学检查，如果是传统的，则每年重复一次。灵敏度的提高，明显的成本效益，以及具有代表性的样本进行辅助检测的优势，支持使用LBC。
This article reviews the data available as of 2004 on the effectiveness and cost-effectiveness of cervical screening with the two available cytologic methods, the conventional Papanicolaou (Pap; CP) smear and liquid-based cytology (LBC), and discusses the application of LBC to current practice. The majority of LBC studies are on the ThinPrep Pap Test (CYTYC, Boxsborough, MA) and the remainder are on SurePath (TriPath, Burlington, NC), which was previously known as AutoCyte Prep. LBC identified more low-grade squamous intraepithelial lesion (LSIL) Pap test results compared with paired conventional cytology in 17 of 21 ThinPrep and 9 of 12 SurePath "split-sample" studies considered to fulfill the criteria for inclusion in the British NHS Health Technology Assessment (HTA) evaluation of cervical cytology. In four of the six recent ThinPrep and one of two SurePath split-sample studies, more high-grade squamous intraepithelial lesion-positive (HSIL+) results were identified by LBC than by CP. All 15 "direct-to vial studies" meeting HTA criteria reported more LSIL+ results for LBC compared with CP, and all eight of the direct-to-vial studies reporting HSIL+ results separately showed increased detection of high-grade cytology interpretations. Fifteen studies met the criteria for evaluating sensitivity and specificity. Aggregate sensitivity for the CP was 71.5% and for LBC was 80.1%. Indirect comparisons of the two LBC methods did not detect a difference in sensitivity, and a meta-analysis of the six studies comparing specificity between CP and LBC found no difference. Other capabilities of LBC are improved specimen adequacy and the ability to do ancillary testing out of the liquid-based vial. In cost-effective analyses based on models of disease natural history and/or the clinical effectiveness of each screening modality, screening with CP was always dominated by screening with LBC. Primary cervical screening guidelines issued by the American Cancer Society in 2002 recommend repeating the cytology biannually if liquid-based and annually if conventional. The gain in sensitivity, apparent cost-effectiveness, and advantage of having a representative specimen for ancillary testing, support the use of LBC.
影响因子：
120.7
作者：
Kulasingam, SL;Hughes, JP;Koutsky, LA
通讯作者：
Koutsky, LA