液基细胞学对宫颈癌前病变的诊断价值：随机对照试验的系统评价_《中国循证医学杂志》

作者：

李克敏 ¹ ,  尹如铁 ¹ , 康德英 ² , 伍伟伟 ³ , 文进 ²

1. 四川大学华西第二医院妇科（成都?610041）；2. 四川大学华西医院循证医学与临床流行病学教研室（成都?610041）；3. 四川大学华西第二医院病理科（成都?610041）;

关键词：

宫颈癌前病变液基细胞学传统细胞学宫颈癌筛查系统评价

DOI：

10.7507/1672-2531.20110191

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价液基细胞学与传统细胞学对宫颈癌前病变的诊断价值。
方法　计算机检索PubMed、EMbase、Cochrane Library、Cochrane临床对照试验中心注册库、CNKI和CBM，检索时间均从建库至2010年6月，收集比较液基细胞学与传统细胞学诊断宫颈癌前病变的随机对照试验。由2位评价员独立根据纳入排除标准筛选文献、提取资料并评价质量后，采用RevMan 5.0软件和Metadisc 1.4软件进行Meta分析。
结果　共纳入5个随机对照试验，合计149 287例研究对象。其中液基细胞学组69 785例，传统细胞学组79 537例。Meta分析结果显示，以宫颈细胞学提示未明确诊断意义的非典型鳞状上皮细胞（ASCUS）为异常临界值时，与传统细胞学相比，液基细胞学在筛查宫颈上皮内瘤变3级及其更高级别病变（CIN3+）时的特异度更高，其差异有统计学意义［RR=0.97，95%CI（0.97，0.97）， P lt;0.000 01］；在高危人群中，液基细胞学筛查宫颈上皮内瘤变2级及其更高级别病变（CIN2+）时的特异度高于传统细胞学，其差异有统计学意义［RR=1.01，95%CI（1.01，1.01）， P lt;0.000 01］。但液基细胞学与传统细胞学在其他各组分析中的差异无统计学意义（P gt;0.01）。
结论　现有证据显示，与传统细胞学筛查相比，在常规参加宫颈癌筛查的健康人群中，液基细胞学既不提高其筛查宫颈癌前病变的敏感性，也不提高其特异性；但在高危人群中，似乎可以提高其筛查宫颈癌前病变的特异性。

引用本文： 李克敏,尹如铁,康德英,伍伟伟,文进. 液基细胞学对宫颈癌前病变的诊断价值：随机对照试验的系统评价. 中国循证医学杂志, 2011, 11(10): 1133-1139. doi: 10.7507/1672-2531.20110191 复制

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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.
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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.	邹维霞, 李国俊. 液基超薄涂片与传统宫颈涂片在筛查宫颈癌方面的研究. 中国妇幼保健, 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. 邹维霞, 李国俊. 液基超薄涂片与传统宫颈涂片在筛查宫颈癌方面的研究. 中国妇幼保健, 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.

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液基细胞学对宫颈癌前病变的诊断价值：随机对照试验的系统评价

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《中国循证医学杂志》

液基细胞学对宫颈癌前病变的诊断价值：随机对照试验的系统评价

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