Evaluation Of Multiple Screening Schemes For Cervical Cancer In Xinjiang

Objective:1.To investigate the incidence of cervical cancer,the current situation of early diagnosis and relevant basic information of the investigators by screening cervical cancer in rural area women in Kashgar Prefecture,Marabishi County,Xinjiang.And to evaluate the diagnosis of primary screening methods such as VIA/VILI and care HPV.Through the systematic evaluation of various screening programs,it is proposed to find effective screening methods for cervical cancer suitable for women in rural areas of Xinjiang.To evaluate the value of cervista,cobas,aptima HPV detection and TCT in the initial screening of care HPV in predicting cervical lesions in rural area women.2.Through the examination of care and HC2 high-risk HPV in ASC-US patients in our hospital's gynaecological outpatient department,to verify the consistency of care and HC2 high-risk HPV testing.Methods:1.From August 10,2015 to September 20,2015,there were 3,000 married women investigated,who were aged 35-64 in 4 townships and 2 towns in Marabishi County.During this time,interviews were conducted on the women's basic information and behavioral factors,and gynaecological examinations were conducted.Among them,1993 women underwent the care HPV test,and 1007 women underwent visual inspection with staining(VIA)and visual inspection with iodine staining(VILI).The care HPV-positive patients were detected by cervisa-HPV,cobas-HPV,aptimaHPV test,the cervical liquid-based cytology test,One of the care HPV and VIA/VILI with positive patients underwent the colposcopy cervical biopsy.Firstly,a preliminary analysis of the screening results of cervical cancer in Uygur women in Marabishi County was carried out.Secondly,the pathological histological results were used as the gold standard,and the sensitivity(Se),specificity(Se),and area under the ROC curve(AUC)of the screening method werecalculated systematically to evaluate various screening methods.The simulation combination formed several screening protocols for cervical cancer and evaluated the screening protocol.Through comprehensive analysis of feasibility and influencing factors,we will explore cervical cancer screening strategies suitable for rural areas in Xinjiang.2.From June 2016 to June 2017,there were 120 women in ASC-US who were 21-64 years old in the gynaecology clinic of our hospital.A colposcopy cervical biopsy was performed using the high-risk type of care HPV and HC2 HPV.Using the histopathological results as the gold standard,the diagnostic indicators of various screening methods were calculated,verify the consistency of care and HC2 high-risk HPV testing for ASC-US patients.Results:1.In the screening study of cervical cancer in Marabishi County,the number of screenings should be 3,000,and the actual number of screenings was 3,000.The questionnaire was completed on the spot and screening for cervical cancer was completed,which the completion rate was 100%.There were no significant differences in the distribution of basic information(age,marital status,education,family income,occupation,etc.)and behavioral factors(menarche age,first sexual behavior age,first marriage age,number of live births,menopause,etc.)(P>0.05).The educational level of the screening subjects was generally low,and the education level of junior high school and below accounted for 77.87%.The minimum age of the respondents was 35 years,the maximum age was 64 years,and the average age was 44.95±6.66 years.There were 569 total cervical biopsies,including 500 patients with chronic cervicitis,35 patients with CINI,9patients with CINII,21 patients with CINIII,and 4 patients with squamous cell carcinoma.The positive rate was 2.3%(69/3000),the detection rate of cervical intraepithelial neoplasia(CIN2 +)with CINII and above was 1.13%(34/3000).2.Characteristics of the screening methods: VIA/VILI group: the positive rate of VIA/VILI was 7.85%.No cancer was found in the pathological results.There were 9 cases of CIN ? and above,with a detection rate of 0.89%.The Se of VIA,VILI is 55.6%,and the Sp is 68.3%,68.8%,respectively.There were no significant differences in the diagnostic evaluation of the two screening methods of VIA and VILI(P>0.05).There were no significant differences between the VIA and VILA screening methods in the diagnosis results of gynecologists in our hospital and Marabishi County Maternal and Child Health Hospital(P>0.05).And there were no significant differences between the VIA and VILA screening methods in the menopausal and non-menopausal women(P>0.05).HPV group: The positive rate of HPV was 10.9%.Squamous cell carcinoma in 4cases,CIN ? and above in 25 cases,the detection rate was 1.25%.The experiments have shown that HPV infection rates have two peak ages: 40-45 and 60-64 years old.The incidence of CINII-grade lesions in women aged 50-54 is high.The Se,Sp,PPV,and NPV detected by care HPV were 92%,42.3%,10.6%,and 98.6%,respectively.As the pathological level increases,the positive rate of HPV test results was also gradually increasing.In each of the screening methods,the primary screening effects of care HPV and VIA/VILI were compared with each other.The comparison found that the area under the ROC curve obtained from the care HPV screening test was 0.671,which was higher than the area under the ROC curve of the VIA/VILA test method(AUC=0.619);the care HPV Kappa value(0.075)was higher than VIA/VILI(0.058),and the diagnostic value of care HPV was higher than the VIA/VILA test method.3.Initial screening of care HPV,we simulated and combined various shunt methods.In Cobas,Cervista,Aptima HPV detection and TCT shunt method,the area under the ROC curve obtained by TCT shunt method was the largest,the AUC was 0.802,the sensitivity was 64%,the specificity was 96.4%,the positive predictive value was 57.1%,and the negative predictive value was 97.3%.Secondly,the area under the ROC curve obtained by the Cervista split method was larger,the AUC was 0.747,the sensitivity was84.0%,the specificity was 65.5%,the positive predictive value was 15.3%,and the negative predictive value was 95.2%.The third was the Cobas shunt method,with AUC of0.723,sensitivity of 92.0%,specificity of 52.7%,positive predictive value of 12.6%,and negative predictive value of 98.9%.The area under the ROC curve obtained by the Aptima shunt method was relatively minimal,with an AUC of 0.679,sensitivity of 95.7%,specificity of 40.2%,positive predictive value of 15.9%,and negative predictive value of98.7%.It is suggested that the care HPV primary screening TCT shunt method is the most valuable for screening for cervical cancer.4.In the ASC-US patients shunt screening,the pathological biopsy was 4 cases of squamous cell carcinoma.The detection rate of CIN2 above lesions was 23.33%(28/120).The detection rates of high-grade lesions in HC2 high-risk HPV-DNA positive and negative groups were 37.7% and 3.9%,respectively(P < 0.01).The detection rates of high-grade lesions in the positive group and the negative group of care HPV were 37.5%and 7.1%,respectively(P<0.01).The Kappa value of HC2 and care HPV was 0.815,which was in a good agreement.The histopathological diagnosis as the gold standard,the sensitivity,specificity,positive predictive value and negative predictive value of high-grade lesions predicted by HC2 and care HPV were 92.9%,53.3%,37.7%,and96.1%,respectively;85.7%,56.5%,37.5%,92.9%,respectively.The area under the ROC curve of the HPV test was 0.731 and 0.711,respectively,which the area under the ROC curve of the two methods was similar.Conclusions:1.The detection rate of the CINII above level lesions of Uighur women in Marabishi County,Xinjiang is 1.13%.The HPV infection rate(10.89%)is lower than other high-risk areas of cervical cancer in China.Women with 50-54 years old have a high incidence of the CINII above level lesions.The HPV infection rate has two peak ages,40-44 and 60-64 years old.2.Comparing VILI with VIA,the accuracy of screening for cervical precancerous lesions and cancer is identical.Both VIA and VILI screening methods have low sensitivity and specificity,but at a lower cost.They can be repeated,without the need for laboratory personnel and equipment,when to check and when to treat,reduce loss of follow-up,and very suitable for use in underdeveloped areas.There is nosignificant difference between the diagnosis results of gynaecologists in our hospital and Marabishi County Maternal and Child Health Hospital.Strengthening the specialist training of grassroots gynaecologists can achieve the expected results.VIA/VILI can be applied to postmenopausal women in areas where cervical cancer screening has not been performed.3.Comparing the primary screening effects of care HPV and VIA/VILI,the diagnostic value of care HPV is higher than the VIA/VILA detection method.Although VIA/VILI is still a valuable screening method for cervical cancer in rural areas,it is subjective.If the conditions permit,promote the use of care HPV in rural areas.4.Initial screening of care HPV.In various simulation methods such as Cobas,Cervista,Aptima HPV detection and TCT method shunt,the area under the ROC curve obtained by TCT shunt is the largest,and the care HPV primary screening TCT shunt is the most valuable for cervical cancer screening.Cervista HPV detection is in good agreement with care HPV detection.When cytological diagnosis is insufficient,it can be used as a sensitive shunt method for care HPV detection in cervical cancer screening.5.High-risk HPV detection technology has a high detection effect on ASC-US patients.In such patients,Using the histopathological results as the gold standard,the consistency of care and HC2 HPV detection is high,care HPV can be used in cervical cancer screening in rural areas of Xinjiang.