液基細胞學對宮頸癌前病變的診斷價值：隨機對照試驗的系統評價_《中國循證醫學雜志》

作者：

李克敏 ¹ ,  尹如鐵 ¹ , 康德英 ² , 伍偉偉 ³ , 文進 ²

1. 四川大學華西第二醫院婦科（成都?610041）；2. 四川大學華西醫院循證醫學與臨床流行病學教研室（成都?610041）；3. 四川大學華西第二醫院病理科（成都?610041）;

關鍵詞：

宮頸癌前病變液基細胞學傳統細胞學宮頸癌篩查系統評價

DOI：

10.7507/1672-2531.20110191

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目的　系統評價液基細胞學與傳統細胞學對宮頸癌前病變的診斷價值。
方法　計算機檢索PubMed、EMbase、Cochrane Library、Cochrane臨床對照試驗中心注冊庫、CNKI和CBM，檢索時間均從建庫至2010年6月，收集比較液基細胞學與傳統細胞學診斷宮頸癌前病變的隨機對照試驗。由2位評價員獨立根據納入排除標準篩選文獻、提取資料并評價質量后，采用RevMan 5.0軟件和Metadisc 1.4軟件進行Meta分析。
結果　共納入5個隨機對照試驗，合計149 287例研究對象。其中液基細胞學組69 785例，傳統細胞學組79 537例。Meta分析結果顯示，以宮頸細胞學提示未明確診斷意義的非典型鱗狀上皮細胞（ASCUS）為異常臨界值時，與傳統細胞學相比，液基細胞學在篩查宮頸上皮內瘤變3級及其更高級別病變（CIN3+）時的特異度更高，其差異有統計學意義［RR=0.97，95%CI（0.97，0.97）， P lt;0.000 01］；在高危人群中，液基細胞學篩查宮頸上皮內瘤變2級及其更高級別病變（CIN2+）時的特異度高于傳統細胞學，其差異有統計學意義［RR=1.01，95%CI（1.01，1.01）， P lt;0.000 01］。但液基細胞學與傳統細胞學在其他各組分析中的差異無統計學意義（P gt;0.01）。
結論　現有證據顯示，與傳統細胞學篩查相比，在常規參加宮頸癌篩查的健康人群中，液基細胞學既不提高其篩查宮頸癌前病變的敏感性，也不提高其特異性；但在高危人群中，似乎可以提高其篩查宮頸癌前病變的特異性。

引用本文： 李克敏,尹如鐵,康德英,伍偉偉,文進. 液基細胞學對宮頸癌前病變的診斷價值：隨機對照試驗的系統評價. 中國循證醫學雜志, 2011, 11(10): 1133-1139. doi: 10.7507/1672-2531.20110191 復制

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6.	Arbyn M, Bergeron C, Klinkhamer P, et al . Liquid compared with conventional cervical cytology: a systematic review and meta-analysis. Obstatrics & Gynecology , 2008, 11(1): 167-177.
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13.	Cochran WG. The combination of estimates from different experiments. Biometrics , 1954, 10(6): 101-129.
14.	Higgins JP, Thompson SG, Deeks JJ, et al . Measuring inconsistency in meta-analyses. BMJ , 2003, 327(7414): 557-560.
15.	Taylor S, Kuhn L, Dupree W, et al . Direct comparison of liquid-based and conventional cytology in a South African screening trial. Int J Cancer , 2006, 118(4): 957-962.
16.	Ronco G, Cuzick J, Pierotti P, et al . Accuracy of liquid based versus conventional cytology：overall results of new technologies for cervical cancer screening randomised controlled trial. BMJ , 2007, 335(7609): 28.
17.	Maccallini V, Angeloni C, Caraceni D, et al . Comparison of the conventiontional cervical smear and liquid-based cytology: results of a controlled, prospective study in the Abruzzo region of Italy. Acta Cytol , 2008, 52(5): 568-574.
18.	Sykes PH, Harker DY, Miller A, et al . A randomised comparison of SurePath liquid-based cytology and conventional smear cytology in a colposcopy clinic setting. BJOG , 2008, 115(11): 1375-1381.
19.	Siebers AG, Klinkhamer PJ, Grefte JM, et al . Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors: a randomized controlled trial. JAMA , 2009, 302(16): 1757-1764.
20.	Ronco G, Segnan N, Giorgi-Rossi P, et al . Human papillomavirus testing and liquid-based cytology: results at recruitment from the new technologies for cervical cancer randomized controlled trial. J Natl Cancer Inst , 2006, 98(11): 765-774.
21.	Ronco G, Giorgi-Rossi P, Carozzi F, et al . Human papillomavirus testing and liquid-based cytology in primary screening of women younger than 35 years: results at recruitment for a randomised controlled trial. Lancet Oncol , 2006, 7(7): 547-555.
22.	Giorgi-Rossi P, Segnan N, Zappa M, et al . The impact of new technologies in cervical cancer screening: Results of the recruitment phase of a large randomized controlled trial from a public health perspective. Int J Cancer , 2007, 121(12): 2729-2734.
23.	Partridge EE, Abu-Rustum N, Campos SM, et al . Cervical cancer screening. V.1.2010. NCCN clinical practice guidelines in oncology. Available from: URL: http://www.nccn.org.
24.	鄒維霞, 李國俊. 液基超薄涂片與傳統宮頸涂片在篩查宮頸癌方面的研究. 中國婦幼保健, 2004, 19(15): 52-53.
25.	Strander B, Andersson-Ellström A, Milsom I, et al . Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program：a prospective randomized study. Cancer , 2007, 111(5): 285-291.

1. 2 Hutchinson ML, Zahniser DJ, Sherman ME, et al . Utility of liquid-based cytology for cervical carcinoma screening: results of a population-based study conducted in a region of Costa Rica with a high incidence of cervical carcinoma. Cancer , 1999, 87(2): 48-55.
2. Disaia PJ, Creasman WT. Clinical gynecologic oncology. 6th ed. Health Science Asia, Elsevier Science, 2002: 12-14.
3. Monsonego J, Autillo-Touati A, Bergeron C, et al . Liquid-based cytology in the primary screening for cervical cancer: a multicenter study. Br J Cancer , 2001, 84(3): 360-366.
4. Ferenczy A, Robitaille J, Franco E, et al . Conventional cervical cytologic smears vs. ThinPrep smears. A paired comparison study on cervical cytology. Acta Cytol , 1996, 40(6): 1136-1142.
5. Bernstein SJ, Sanchez-Ramos L, Ndubisi B. Liquid-based cervical cytologic smear study and conventional papanicolaou smears：a metaanalysis of prospective studies comparing cytologic diagnosis and sample adequacy. Am J Obstet Gynecol , 2001, 185(2): 308-317.
6. Arbyn M, Bergeron C, Klinkhamer P, et al . Liquid compared with conventional cervical cytology: a systematic review and meta-analysis. Obstatrics & Gynecology , 2008, 11(1): 167-177.
7. Solomon D, Davey D, Kurman R, et al . The 2001 Bethesda System：terminology for reporting results of cervical cytology. JAMA , 2002, 287(16): 2114-2119.
8. Richart RM. Cervical intraepithelial neoplasia. Pathol Annu , 1973, 8(62): 301-328.
9. de Vet HCW, Eisinga A, Riphagen II, et al . Searching for studies//Deeks JJ,Bossuyt PM,Gatsonis C. Cochrane handbook for diagnostic test accuracy version 1.0.0. The Cochrane Collaboration 2008. Available from: URL: http://srdta.cochrane.org.
10. Smidt N, Deeks J, Moore T. Guide to the contents of a Cochrane review and protocol for Diagnostic Test Accuracy version 1.0.1 (updated February 2008). The Conchrane Collaboration 2008. Available from: URL: http://srdta.cochrane.org.
11. Whiting P, Rutjes AW, Reitsma JB, et al . The development of QUADAS：a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. B MC Med Res Methodol , 2003. Available from：URL：http://www.biomedcentral.com/1471-2288/3/25.
12. Whiting PF, Weswood ME, Rutjes AW, et al . Evaluation of QUADAS，a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol , 2006. Available from: URL: http://www.biomedcentral.com/1471-2288/6/9.
13. Cochran WG. The combination of estimates from different experiments. Biometrics , 1954, 10(6): 101-129.
14. Higgins JP, Thompson SG, Deeks JJ, et al . Measuring inconsistency in meta-analyses. BMJ , 2003, 327(7414): 557-560.
15. Taylor S, Kuhn L, Dupree W, et al . Direct comparison of liquid-based and conventional cytology in a South African screening trial. Int J Cancer , 2006, 118(4): 957-962.
16. Ronco G, Cuzick J, Pierotti P, et al . Accuracy of liquid based versus conventional cytology：overall results of new technologies for cervical cancer screening randomised controlled trial. BMJ , 2007, 335(7609): 28.
17. Maccallini V, Angeloni C, Caraceni D, et al . Comparison of the conventiontional cervical smear and liquid-based cytology: results of a controlled, prospective study in the Abruzzo region of Italy. Acta Cytol , 2008, 52(5): 568-574.
18. Sykes PH, Harker DY, Miller A, et al . A randomised comparison of SurePath liquid-based cytology and conventional smear cytology in a colposcopy clinic setting. BJOG , 2008, 115(11): 1375-1381.
19. Siebers AG, Klinkhamer PJ, Grefte JM, et al . Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors: a randomized controlled trial. JAMA , 2009, 302(16): 1757-1764.
20. Ronco G, Segnan N, Giorgi-Rossi P, et al . Human papillomavirus testing and liquid-based cytology: results at recruitment from the new technologies for cervical cancer randomized controlled trial. J Natl Cancer Inst , 2006, 98(11): 765-774.
21. Ronco G, Giorgi-Rossi P, Carozzi F, et al . Human papillomavirus testing and liquid-based cytology in primary screening of women younger than 35 years: results at recruitment for a randomised controlled trial. Lancet Oncol , 2006, 7(7): 547-555.
22. Giorgi-Rossi P, Segnan N, Zappa M, et al . The impact of new technologies in cervical cancer screening: Results of the recruitment phase of a large randomized controlled trial from a public health perspective. Int J Cancer , 2007, 121(12): 2729-2734.
23. Partridge EE, Abu-Rustum N, Campos SM, et al . Cervical cancer screening. V.1.2010. NCCN clinical practice guidelines in oncology. Available from: URL: http://www.nccn.org.
24. 鄒維霞, 李國俊. 液基超薄涂片與傳統宮頸涂片在篩查宮頸癌方面的研究. 中國婦幼保健, 2004, 19(15): 52-53.
25. Strander B, Andersson-Ellström A, Milsom I, et al . Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program：a prospective randomized study. Cancer , 2007, 111(5): 285-291.

《中國循證醫學雜志》

液基細胞學對宮頸癌前病變的診斷價值：隨機對照試驗的系統評價

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《中國循證醫學雜志》

液基細胞學對宮頸癌前病變的診斷價值：隨機對照試驗的系統評價

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