| Objectives:To understand the HPV infection rate,subtype,and epidemiological characteristics of women population in rural areas of Jiangxi Province.To evaluate the clinical performance and effectiveness of different specimens of HPV screening and different triage methods after primary screening,and to explore cost-effective HPV screening ways for cervical cancer in Jiangxi rural areas in China.Materials and Methods:1.Based on the 2014~2017 "China Anti-Cancer Association Cervical Cancer Screening and Relief Project",2015~2018 "Investigation and Research Project on the Distribution of HPV Infection Genotype of Women’s Cervical Diseases in Different Areas of Jiangxi" and2017 ~ 2018 "Population-based cervical cancer screening projects with the establishment of a cervical cancer screening project".The cross-sectional population-based screening surveyed hr-HPV infection status,genotype,and epidemiological characteristics in seven different regions of Jiangxi Province in China.We identified the dominant hr-HPV genotype in cervical cancer and precancerous lesions in this region,and analyzed the HPV genotype and relationship between pathological characteristics and age distribution of cervical cancer patients.In contrast,the top three HPV subtype distributions of HSIL and cervical invasive carcinoma hospitalized patients were also HPV16,HPV52,and HPV58 in the same period.2.Women who with positive result hr-HPV screening were judged as triage results positive triages using cytology≥ASCUS,HPV16 / 18(+),HPV16/18/52/58(+),HPV load≥10 RLU / CO or VIA / VILI(+),by screening methods for population-based cervical cancer HPV screening in seven rural areas.The pathological gold standard was benchmarked to evaluate the colposcopy referral rate and sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),the area under ROC(Receiver Operating Characteristic)and screening cost of 6 triage waysfor identifying HSIL+ lesions.3.Based on the porject "2018 ~ 2019 Construction and application of selfsampling cervical cancer screening-management model based on the Internet".2000 women aged 35 ~64 were detected by HPV self-sampling test from September to November 2019,in the "National Two Cancers Screening Project" located Dexing City,Jiangxi Province.Each woman was performed HPV self-sampling(Women who participated in the screening themselves to obtain vaginal cervical exfoliated cells)and doctor-collected methods at same time.Two specimens were tested by BMRT HPV which can include 14 high-risk HPV genotype(HPV 16,18,31,33,35,39,45,51,52,53,56,59,68)and viral load.Evaluate the two sampling ways screening efficacy.Results:1.hr-HPV infection rate was 13.56%(2413/17783)in the study,for 17,783 women were included at the seven screening areas.7,911 women were tested for high-risk HPV genotype test among the 17,783,major infection genotype top ten were ranked as HPV52 and HPV58.,HPV16,HPV68,HPV51,HPV56,HPV35,HPV18,HPV39,HPV33.The genotype among invasive cervical cancer cases were ranked as HPV16,HPV18,HPV52,HPV58;the HSIL + cases were ranked as HPV16,HPV52,HPV58,HPV18.2.The triage of HPV16/18/52/58 have the highest sensitivity for detecting HSIL+ after the primary screening of hr-HPV(85.71%)in the six triage methods;the highest specificity is the HPV16 / 18 triage(85.95%).The area under the ROC of each triage method is: liquid-based cytology: 0.678,Pap smear: 0.664,HPV16/18:0.758,HPV16/18/52/58: 0.643,HPV virus load 0.717,VIA/VILI: 0.599.Considering the screening costs of colposcopy referrals and the times of callback after primary screening,HPV16/18/52/58 triage had the lowest cost of detecting one HSIL+ case per screen(6905.3 RMB).3.A total of 1819 women with complete data were detected by HPV selfsampling test.The positive coincidence rate was 83.6% of self-sampling test and doctor-collected test,the negative coincidence rate was 96.8%,the total coincidencerate was 94.7%,Kappa = 0.801(P<0.05).Its positive coincidence rate was 86.3% of HPV self-sampling specimen solid transfer detection method and doctor-collected liquid storage detection method,and the negative coincidence rate of 96.7%,a total coincidence rate of 95.2%,Kappa = 0.815(P<0.05).Conclusions:1.The dominant genotype are HPV52,HPV58 and HPV16 based on this study of women aged 35-64 years in seven rural cervical cancer screening areas of Jiangxi Province.2.The triage of HPV16/18 genotype,HPV virus load or HPV16/18/52/58 genotype are suitable for hr-HPV primary screening positive triages in these rural areas.In view of the distribution of HPV subtypes,HPV16/18/52/58 genetype triage may be a suitable way in this area.3.The screening efficacy of HPV self-sampling is the same as that of doctor-collected way,which provides a new path for improving the coverage of cervical cancer screening in China’s rural areas. |
PDF Full Text Request