ISO15189 ～醫學實驗室管理交流～

傳統子宮頸抹片與液態薄層抹片的篩檢效能相同

有一篇發表在10月28日出刊的報告（JAMA. 2009;302(16):1757-1764）認為液態薄層抹片（liquid-based cytology）對早期子宮頸的篩檢效能並沒有比傳統子宮頸抹片（conventional cervical cytology）要好。

該報告是在荷蘭進行的一項大型隨機研究（a large randomized study），共有89,784名婦女（年齡30-60歲）參與子宮頸篩檢計畫，由246家家庭醫師診所執行篩檢工作。其中122家被指定使用液態薄層抹片，共篩檢49,222名婦女；124家被指定使用傳統子宮頸抹片，共篩檢40,562名婦女。篩檢計畫自2004年4月至2006年7月1日共進行二年多。所有參與者再追蹤18個月，至2008年1月31日結束。

檢出率參閱下列二表：

Detection Rates, Intention-to-Treat Analysis: Liquid-Based Cytology vs Pap Test

CIN=cervical intraepithelial neoplasia

Detection Rates, Per-Protocol Analysis: Liquid-Based Cytology vs Pap Test

【論文摘要】

Comparison of Liquid-Based Cytology With Conventional Cytology for Detection of Cervical Cancer Precursors

A Randomized Controlled Trial

Albertus G. Siebers, MSc; Paul J. J. M. Klinkhamer, MD; Johanna M. M. Grefte, MD, PhD; Leon F. A. G. Massuger, MD, PhD; Judith E. M. Vedder; Angelique Beijers-Broos; Johan Bulten, MD, PhD; Marc Arbyn, MD, MSc, DrTMH

JAMA. 2009;302(16):1757-1764.

Context  Liquid-based cytology has been developed as an alternative for conventional cervical cytology. Despite numerous studies and systematic reviews, controversy remains about its diagnostic accuracy.

Objective  To assess the performance of liquid-based cytology compared with conventional cytology in terms of detection of histologically confirmed cervical intraepithelial neoplasia (CIN).

Design, Setting, and Participants  Cluster randomized controlled trial involving 89 784 women aged 30 to 60 years participating in the Dutch cervical screening program at 246 family practices. One hundred twenty-two practices were assigned to use liquid-based cytology and screened 49 222 patients and 124 practices were assigned to use the conventional Papanicolaou (Pap) test and screened 40 562 patients between April 2004 and July 1, 2006. Patients were followed up for 18 months through January 31, 2008.

Intervention  Screening for CIN using liquid-based cytology or conventional papanicolaou (Pap) test and the blinded review of all follow-up of screen-positive women (blinded to the type of cytology and the initial result).

Main Outcome Measures  Intention-to-treat and per-protocol analysis of the detection rates of and positive predictive values for histologically verified CIN in both cytology systems. Outcomes are presented as crude and adjusted rate ratios (adjustment for age, urbanization, study site, and period).

Results  The adjusted detection rate ratios for CIN grade 1+ was 1.01 (95% confidence interval [CI], 0.85-1.19); for CIN grade 2+, 1.00 (95% CI, 0.84-1.20); for CIN grade 3+, 1.05 (95% CI, 0.86-1.29); and for carcinoma, 1.69 (95% CI, 0.96-2.99). The adjusted positive predictive value (PPV) ratios, considered at several cytological cutoffs and for various outcomes of CIN did not differ significantly from unity.

Conclusion  This study indicates that liquid-based cytology does not perform better than conventional Pap tests in terms of relative sensitivity and PPV for detection of cervical cancer precursors.

【資料來源】

1. JAMA

http://jama.ama-assn.org/cgi/content/abstract/302/16/1757?home=

2. Medscape

http://cme.medscape.com/viewarticle/711852?sssdmh=dm1.553076&src=nldne&uac=43456SG

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