HPV E6/E7 mRNA联合薄层液基细胞学检测在宫颈癌筛查中的应用价值

目的分析人乳头状瘤病毒(HPV) E6/E7 mRNA联合薄层液基细胞学检测(TCT)在宫颈癌筛查中的应用价值。方法选取2017年7月-2019年1月在海宁市妇幼保健院妇科就诊的12 000例女性为研究对象,均先行Aptima HPV筛查,Aptima HPV筛查异常的给予TCT和组织病理活检。分析单独TCT、HPV E6/E7 mRNA及两者联合诊断宫颈癌的灵敏度及特异度。结果12 000名女性中,共1 712例进行了Aptima HPV筛查、TCT及组织病理活检。Aptima HPV阳性率随TBS分级、组织病理分级增加而增高(P0.05)。Aptima HPV诊断≥CINⅡ级宫颈病变的灵敏度、阴性预测值明显高于TCT检查(P0.05); TCT+Aptima HPV联合检测诊断宫颈病变的灵敏度、阴性预测值明显高于单独Aptima HPV、TCT检查(P0.05)。结论 Aptima HPV作为早期筛查宫颈癌的手段,可减少不必要的阴道镜活检,缓解患者心理压力,与TCT联用的诊断灵敏度更高,对于临床防治宫颈癌、减少宫颈癌死亡率具有重要意义。     

TCT与HPV联合检测在健康体检宫颈癌筛查中的应用

目的:薄层液基细胞学(TCT)与HPV-DNA联合检测在健康体检宫颈癌筛查中的应用效果.方法:选取2015年6月~2016年6月在我院行宫颈癌筛查健康体检的1200例女性患者进行分析,对所有患者均采取TCT联合HPV进行检测,TCT和HPV检测中一项或者两项存在异常时进行病理组织活检.结果:1200例健康体检者中TCT或HPV检测一项或者两项异常者共302例,TCT检查显示阳性者300例,而病理检查结果阳性者101例,两者符合率为33.7%,HPV-DNA检查结果为阳性者152例,而病理检查结果阳性者80例,两者符合率为52.6%,TCT联合HPV检查阳性者112例,病理检查阳性者102例,两种符合率为91.1%,TCT和HPV联合检查与病理检查结果符合率明显高于单纯TCT或HPV检查符合率.结论:TCT联合HPV检查技术有利于增加健康体检患者宫颈癌的筛查率,该方法是一种快捷且高效的宫颈癌检测方法.     

高危型HPV检测及TCT检查在宫颈癌筛查中的应用效果分析

目的 探讨高危型人乳头瘤病毒(human papilloma virus,HPV)检测及液基薄层细胞学检查(thinprep cytology test,TCT)在宫颈癌筛查中联合应用的效果。方法 选择2019年1月-2021年12月在本院接受宫颈癌筛查的26324例女性受检者作为研究对象,对其进行HPV初筛,再对HPV初筛阳性病例进行阴道镜检查或TCT,统计宫颈癌筛查结果。结果 26324例女性经HPV初筛,共检出2547例HPV阳性,包括HPV16/18型阳性409例、其他类型HPV阳性2138例,占筛查总人数的9.67%。那么,只需要这部分人进行后续的TCT检查。HPV16/18型阳性409例中,204例患者经阴道镜检查确诊6例宫颈癌、110例宫颈癌前病变、88例阴性。其他类型HPV阳性2138例中,有1589例患者接受TCT,TCT结果显示1164例阴性、425例阳性,425例TCT阳性患者经阴道镜检查确诊2例宫颈癌、92例宫颈癌前病变、200例阴性。结论 高危型HPV检测联合TCT检查对宫颈癌及癌前病变具有良好的筛查价值,在临床上值得推广。     

HPV-DNA与血清SCCA检测在宫颈癌筛查中的意义

目的研究人乳头瘤病毒-DNA(HPV-DNA)与血清鳞状细胞癌抗原(SCCA)检测在宫颈癌筛查中的临床意义,为该病的早发现早干预提供参考。方法选择在某医院妇产科查体的1132例25岁~40岁女性,进行宫颈薄层液基细胞学检查(TCT)及HPV-DNA、SCCA检查。结果各年龄段TCT检测结果构成比差异有显著性(P0.05)。TCT(+)及TCT(-)的入选对象在不同年龄段HPV-DNA及SCCA的阳性率差异无显著性(P0.05)。联合检查HPV-DNA+SCCA+TCT相对于HPV-DNA和SCCA单一及联合检验有更高的准确率。结论在TCT检验的基础上联合检查HPVDNA及SCCA有助于提高宫颈癌的检出率。     

2015—2017年东莞市石碣镇乳腺癌筛查率及影响因素分析

目的 分析2015—2017年东莞市石碣镇适龄妇女参加乳腺癌筛查的情况,并探讨影响乳腺癌筛查率的相关危险因素。 方法 2015—2017年通过免费两癌筛查项目对东莞市石碣镇具有本辖区户籍的适龄女性进行乳腺临床检查、乳腺彩色多普勒超声检查筛查乳腺癌患病情况,采取问卷调查形式对适龄妇女乳腺癌的筛查情况进行调查,收集可能影响乳腺癌筛查率的相关因素。 结果 东莞市石碣镇适龄女性有5 451例,2015—2017年三年完成乳腺癌筛查2 878例,乳腺癌筛查率为52.80%。其中发现乳腺异常1 183例(41.10％),其中乳腺小叶增生809例(28.11％)、乳腺纤维腺瘤317例(11.01％)、乳腺导管扩张49例(1.70％)、可疑乳腺癌8例(0.28％)。不同年龄、户籍、文化程度、月平均收入、既往乳腺疾病史、亲友乳腺癌患病史、是否有乳房自检行为其筛查率不同,其中年龄35～44岁,城市户籍,文化程度高,既往乳腺疾病史,亲友乳腺癌患病史以及有乳房自检行为的研究对象筛查率较高,差异有统计学意义(P＜0. 05)。多因素logistic逐步回归分析发现:年龄(35～岁组OR=2.850,45～岁组OR=2.406)、文化程度(大专及以上组OR=8.699,中学或中专组OR=1.264)、亲友乳腺癌患病史(OR=3.152)、乳房自检行为(OR=1.724)是影响乳腺癌筛查率的独立因素。 结论 东莞市石碣镇女性适龄人群乳腺癌筛查率有待进一步提高;今后筛查工作开展过程中,对高龄、低文化程度、无亲友乳腺癌患病史及无乳房自检行为适龄女性人群,需加强相应的健康宣教,以提高乳腺癌筛查认知水平,进而提高该地区乳腺癌的筛查率。     

HPV或TCT检测对农村地区妇女早期宫颈癌筛查价值对比分析

目的宫颈癌是排名第4的女性常见恶性肿瘤之一,且致病原因明确,可在早期进行预防。本研究以淄博市适龄农村妇女宫颈癌筛查项目为例,比较2种筛查方法在早期宫颈癌筛查中应用效果,旨在探讨合理筛查方案。方法将2014-07-01-2018-12-31参加张店区中埠镇卫生院宫颈癌免费筛查项目的9 788名农村妇女作为研究对象,采用液基细胞学检查(thinprep cytologic test,TCT)和人乳头瘤病毒(human papilloma virus,HPV)检测,并联合阴道镜下活检进行宫颈癌筛查,对比2种检查方法对宫颈癌、非典型鳞状上皮细胞(atypical squamous cell of undefined significance,ASCUS)及以上程度宫颈病变阳性预测值。结果 TCT初筛阳性者490例,阳性率为5.01%;HPV初筛阳性者465例,阳性率为4.75%,2种方法初筛阳性检出率差异无统计学意义,χ~2=0.688,P=0.249。经阴道镜及多点活检病理组织学检查,TCT初筛阳性者宫颈浸润癌6例,非宫颈癌45例,宫颈癌阳性预测值为0.76%,ASCUS及以上程度宫颈病变的阳性预测值为10.41%;HPV初筛阳性者宫颈浸润癌7例,非宫颈癌51例,宫颈癌阳性预测值为1.51%,ASCUS及以上程度宫颈病变的阳性预测值为12.47%,2种检测方法宫颈癌阳性预测值、ASCUS及以上程度宫颈病变阳性预测值比较,差异均无统计学意义,均P0.05。结论 TCT与HPV检测对适龄农村妇女宫颈癌筛查结果并无差异,可根据具体情况选择运用,但尚需扩大样本验证。     

惠东地区城乡女性居民宫颈癌、乳腺癌筛查结果分析

目的分析惠东地区城乡女性居民宫颈癌、乳腺癌的筛查结果。方法以惠东县2014年8月26日至2016年12月31日自愿接受两癌筛查的100 159例城乡妇女为研究对象,通过国家卫生和计划生育委员会制定的筛查表格进行调查问卷,采用DNA倍体定量分析技术、阴道镜检查、液基波层细胞学技术对试检人员及宫颈脱落细胞进行检测,彩色多普勒超声结合钼靶检查对乳腺癌进行筛查,对于两癌阳性患者均进一步进行确诊。结果截止2016年12月31日本院宫颈癌免费筛查发现宫颈癌12例;乳腺癌免费筛查发现乳腺癌22例,均进行了手术或药物治疗。发现生殖道感染9 226例(包括外阴阴道炎4 565例,盆腔炎2 758例,宫颈炎1 903例),生殖系统良性疾病353例,宫颈上皮内瘤变(CIN)101例,乳腺良性疾病325例。乳腺良性宫颈疾病中以卵巢良性肿物多见,为186例(52.69%),子宫肌瘤次之,为154例(43.63%)。良性乳腺疾病中主要为乳腺增生143例(44.00%),乳腺良性肿瘤87例(26.77%),乳腺囊肿54例(16.63%),位居前三。CIN多发于35~39岁年龄段妇女中,次之分别为40~49岁、50~59岁年龄段中,差异具有统计学意义(P0.05),乳腺癌好发于50~59岁年龄段妇女中,次之分别为40~49岁、35~39岁年龄段中,差异具有统计学意义(P0.05),宫颈癌在35~39岁年龄段妇女中检出率略高于其他年龄段,但各年龄段宫颈癌检出率比较差异无统计学意义(P0.05)。结论通过开展两癌筛查工作,可提高妇女两癌的早期诊断率,并通过健康知识宣传等措施可降低两癌的发生率,对于早期治疗及改善预后有重要意义。还应总结筛查经验,逐渐完善筛查制度及筛查年龄范围,提高妇女癌筛查率,建立长效机制,可为妇女的生殖及生命健康提供保障。     

细胞学检查联合高危型人乳头瘤病毒在宫颈癌早期筛查中的价值分析

目的比较高危型人乳头瘤病毒(human papillomavirus,HPV)检测、薄层液基细胞学检查(thinprep cytologic test,TCT)以及高危HPV联合TCT在宫颈癌早期筛查中的价值。方法选取2017年3月至2019年3月在南京医科大学附属苏州医院门诊行妇科体检的女性928例,经过组织病理学证实明确分级。取宫颈细胞样本,进行TCT和高危HPV检测。对TCT、高危HPV以及二者联合检测的阳性率进行比较分析。结果在928例样本中,病理学诊断与高危HPV诊断的阳性率之间差异有统计学意义(P0.0001)。病理学诊断与TCT的阳性率间差异有统计学意义(P0.01)。HPV联合TCT检测的灵敏度为97.08%,特异性为51.00%。与单独进行HPV检测或者TCT检测相比,二者联合检测与组织病理学检查有更高的符合率。结论 HPV检测与TCT检测联合用于筛查宫颈癌具有良好的效果,HPV检测是一种非常有前景的宫颈癌筛查和预防的技术,与TCT检查相结合,应用于宫颈癌早期筛查和诊断,具有一定的临床应用价值。     

人乳头瘤病毒检测、薄层液基细胞学筛查联合阴道镜检查对宫颈癌患者病变前筛选的临床意义

目的探讨宫颈人乳头瘤病毒(HPV)检测、薄层液基细胞学(TCT)筛查联合阴道镜检查在宫颈癌患者病变前筛选中的临床意义。方法选取2015年1月-2017年1月该院收治的460例怀疑宫颈癌女性为研究对象,所有患者均给予HPV检测及TCT筛选,对HPV检测及TCT筛选阳性患者给予阴道镜下宫颈组织活检,然后进行病理组织学检查,以病理组织学检查结果为金标准。结果 TCT筛选正常或炎症患者及非典型鳞状细胞癌(ASCUS)患者HPV检测阳性率均明显低于TCT筛选鳞状上皮内低度病变(LSIL)、鳞状上皮内高度病变(HSIL)及SCC患者;HPV检测联合TCT筛选对HSIL及SCC患者的阳性检出率明显高于炎症或正常患者及LSIL患者;HPV检测、TCT筛选联合阴道镜对LSIL及HSIL患者的检出率明显高于HPV检测联合TCT筛选检出率。结论在宫颈癌筛查中,HPV检测、TCT筛选联合阴道镜检查具有安全、有效及漏诊率低等优点,能大幅度提高宫颈癌患者癌前病变检出率。     

适龄妇女乳腺癌和宫颈癌筛查结果分析和防治措施分析

目的探讨适龄妇女乳腺癌和宫颈癌筛查结果及防治措施。方法选取2022年5月23日-2022年8月30日在泗洪县第一人民医院接受“两癌”筛查的适龄妇女3580例为研究对象。乳腺癌筛查方法有乳腺手诊检查、彩超检查、钼钯检查等;宫颈癌筛查方法有妇科双合诊检查、阴道分泌物显微镜检查、宫颈TCT脱落细胞检查、阴道镜及宫颈活检检查等。总结分析适龄妇女乳腺癌、宫颈癌的检出情况。结果3580例适龄妇女“两癌”筛查的结果:乳腺癌2例,宫颈癌3例,其他妇科疾病有滴虫性阴道炎31例,外阴阴道假丝酵母菌病21例,细菌性阴道病194例,宫颈炎24例,宫颈息肉64例。结论在乡镇普及“两癌”筛查,有助于尽早发现乳腺癌、宫颈癌,进而给予及时、有效的治疗,能够最大限度地确保乡镇适龄妇女的生殖健康。     

乳腺癌合并副乳腺癌诊治探讨

目的 探讨乳腺癌合并副乳腺癌的诊治.方法 2007-2010年收治5例副乳腺癌,其中1例合并乳腺癌,对其临床资料进行综合分析.结果 行乳腺癌改良根治术1例,行副乳腺扩大切除术+腋窝淋巴结清扫术4例.术后均给予化疗及放疗,1例行内分泌治疗.4例随访2年,均未发现复发及转移,1例现正在行术后CAP方案序贯化疗.结论 副乳腺癌是一种罕见且预后较差的恶性肿瘤.诊断主要依靠影像学检查和术后病理.应遵循以手术为主的综合治疗原则,术后辅助治疗有可能改善患者的生存期.     

Pentastomiasis and cancer of the colon

The case is described of a 50-year-old man, admitted to a small mission hospital in Zaire, where a preliminary diagnosis of cancer was made. On referral to a bigger hospital he was found to be infected with Entamoeba histolytica and biopsy of the peritoneal tumour revealed a pentastomid nymph, probably of Armillifer armillatus, the most common pentastomid infecting man in Zaire. X-ray subsequently revealed numerous calcified nymphs. Surgical and anti-parasitic treatment are described and the possible association between pentastomid infection and cancer is discussed.As Self, Hopps & Williams (1975) admit, our knowledge of pentastomiasis in Africa is incomplete and it must be assumed that its occurrence is much more widespread than published reports indicate. It may, therefore, exist throughout much of sub-Saharan Africa, as does liver cancer.Nymphal pentastomiasis in man caused by Armillifer armillatus is generally discovered during surgical intervention or at necropsy. Pathological complications caused by the nymphs are very rare. However, Fain (1975) has drawn attention to the possibility of a carcinogenic action of pentastomids and, although the arguments for this association may be weak, it is an interesting hypothesis bearing in mind the association between clonorchiasis and cancer of the bile-ducts and schistosomiasis and cancer of the urinary bladder. We describe below a case of cancer of the colon accompanied by pentastomiasis.     

Nutrition and the prevention of cancer

Many studies have shown an association between nutrition and cancer and, since one in three people in England will develop cancer and one in four will die from the disease, there is great interest in prevention through diet. The issues are complex and evidence is often limited or equivocal. This review considers the strength of the evidence and puts the risks of cancer in context. It concludes that although no dietary changes can be guaranteed to prevent cancer, on balance there is enough evidence to recommend the current official "healthy eating" guidelines as the best advice for reducing the risk of diet-associated cancers. The greatest protection against cancer coincides with eating more fruit, vegetables and wholegrain foods. Overindulgence in alcohol, smoking, obesity and lack of exercise may interact with dietary factors to increase the risk of some cancers. Healthy lifestyle measures such as regular exercise, avoiding overweight, not smoking and limiting the intake of alcohol can therefore also be recommended as helping to reduce the risk of cancer. When advising individuals, it is necessary to consider all aspects of the person's lifestyle and to bear in mind that there are some limitations to the current evidence. A summary of the practical recommendations for reducing cancer risk is included.     

Diet and cancer of the esophagus

The reported dietary, alcohol consumption and smoking habits of 147 Roswell Park Memorial Institute white male patients diagnosed with cancer of the esophagus were compared with the reports of 264 white males of comparable ages with diagnoses other than cancer. Overall frequency of vegetable and fruit consumption was associated with lower risk; persons reporting fruit and/or vegetable consumption 31–40 times a month had significantly greater risk than those who reported consumption 81 times a month or more. Calculated indexes of vitamin A and vitamin C intake were similarly related to reduction in risk. Dose‐response gradients were observed for frequency of vegetable and/or fruit consumption, as well as for vitamin A and C intake. The putative protective effect of vegetable and fruit intake remained evident after controlling for its possible association with smoking and drinking. Previously reported associations of smoking, alcohol use and social class, as measured by type of occupation, were replicated in these data. The findings of this investigation are consistent with evidence of lower risk associated with vege‐”; table consumption in instances of colon, lung, bladder, oral, and laryngeal cancers, and with evidence of tumor inhibition by vegetable properties in animals. Interpretation of the findings is limited by the difficulties of retrospective assessment of dietary intake and by possible confounding by other factors known to be related to esophageal cancer.     

Costs of breast cancer and the cost-effectiveness of breast cancer screening.

Breast cancer is the second leading cause of death by cancer among women in the United States. The total cost of illness for breast cancer has been estimated to be $3.8 billion, of which $1.8 billion represents medical care costs. It has been estimated that breast cancer detected early is considerably less expensive than when the tumor is discovered at a later stage. Mass screening using mammography can improve early detection by as much as 15-35%. Cost-effectiveness studies have estimated that the costs of breast cancer screening range between $13,200 and $28,000 per year of life saved. The cost-effectiveness of breast cancer screening in the 40-49-year-old age group is controversial. Mass screening for breast cancer will probably increase total health care costs, but when all economic costs are included, screening appears to be more cost-effective than not screening.     

Nutrition and cancer The role of nutrition in the causation of cancer

A link between diet and cancer of a number of varied sites has been observed. The link is probably best documented in colorectal cancer; a plausible mechanism has been proposed and has been tested. A group of hormone-related cancers have been correlated with dietary fat. A group of tobacco-related cancers have also been related to dietary fat, presumably by a different mechanism. Some cancers have been related to alcohol consumption whilst others have been associated with malnutrition in general. This is not, therefore, a homogeneous picture but shows a varied role of diet in disease. It will have been noted that most of these dietary related cancers are diseases of affluence and are associated with ‘overnutrition’. The same diet, however, is associated with low infant mortality and appears to be protective against the more severe effect of virus infections. It may be, therefore, that we should not be hasty in modifying our diet and should first ensure that the benefits that accrue from our current diet are not lost in the change.     

Trends of female mortality from cancer of the breast and cancer of the genital organs

The author reviews the mortality statistics from cancer of the breast in females and from malignant neoplasms of the uterus and of the other female genital organs for nineteen countries over the years 1920-53, first considering the general trend of the mortality series for each group of diseases for all ages and then analysing for each sector of mortality the changes which have occurred in the age-specific deathrates in some pivotal years during the same period.Considerable differences in the levels of total mortality from each group of tumours for various countries are noted. The important variations among age-specific death-rates for cancer of the breast in females and for uterine neoplasms in various countries are examined and their significance is commented upon.     

Nutrition and the cancer patient

The relationship between dietary fat consumption and the incidence of breast cancer, if any, needs to be quantified so that dietary guidelines can be issued for the prevention of breast cancer. Frequently, only two widely different dietary fat levels, often differing in essential fatty acid content, have been compared in animal models. Moreover, the latent period in common animal models for breast cancer is very short and does not reflect the relatively long latent periods in human breast cancer.

We describe a study with BALB/c‐MTV mice, a strain with a high average tumor incidence and a latent period of over 60 weeks on average. The mice were fed diets with fat levels ranging from 10% to 40% of energy, in which fat was isocalorically substituted for carbohydrates. The level of linoleic acid in these diets was kept constant at 6.5% of energy. Both the mean tumor incidence and latent periods of the groups fed diets with 10–16% of energy as fat were not significantly different from each other. There were also no differences between these parameters in the groups fed 22–40% of energy as fat. However, the mean incidence and latent period of the groups fed 22% or more of energy as fat was significantly higher than that of the groups fed less fat. We conclude that above about 22% of energy, fat does not influence the incidence and latent period of mammary tumors in BALB/c‐MTV mice.