■自1971年以来,自2020年1月1日起,首次引入新的宫颈癌筛查法规作为有组织的癌症筛查指南(oKFE-RL)。从20岁开始,每年进行细胞学涂片检查,从35岁开始,每三年进行一次所谓的联合检测(细胞学检查和高危HPV检测).如果出现异常,该算法被用作调查的基础。根据这个诊断算法,即使是所谓的低风险人群也会接受早期阴道镜评估.这种方法已经引起了激烈的辩论,并作为这项注册研究的基础。
■在签署知情同意书后,所有到中心进行阴道镜检查作为诊断算法的一部分的患者都包括在内。获得以下发现:病史,阴道镜检查,组织学,和细胞学发现,以及可能的疗法和他们的发现。目的是评估各组中目标病变宫颈上皮内瘤变(CIN)2/CIN3的频率。
■从2020年7月至2022年10月,共有4763名患者被纳入研究。作为转诊诊断,HPV持续性(HPV:人乳头瘤病毒)与I组被确定为23.9%(1139),II-a组的HPV持续性为2.1%(100),II-p(ASC-US)为11.2%(535),II-g(AGC子宫颈NOS)占1.3%(64)。III-p(ASC-H)和III-g(AGC宫颈内膜有利于肿瘤)分别为9.4%(447)和2.2%(107),分别,IIID1(LSIL)占19%(906),IIID2(HSIL,中度发育不良)在18.9%(898),IVa-p(HSIL,严重发育不良)10.7%(508),IVa-g(AIS)在0.7%(31),IVb-p(具有可疑入侵特征的HSIL)和IVb-g(具有可疑入侵特征的AIS)占0.3%(15),0.1%(6),和7怀疑侵袭V-p(鳞状细胞癌)/V-g(宫颈腺癌)(0.1%)。在IVa-p组中(HSIL,严重发育不良),67.7%的hadCIN2+和56.5%的hadCIN3+,原位腺癌(AIS),和腺癌。如果还评估了基于阴道镜检查结果的切除组织的组织学,在79.7%的病例中发现了CIN2+,67.3%的病例和CIN3+。在IIID2(HSIL,中度发育不良),CIN2+检测为50.9%,和CIN3+/AIS为28.3%。在评估了立即接受手术的患者后,CIN2+和CIN3+/AIS分别增加到53.0%和29.3%。在IIID1(LSIL)中,CIN2+检测到27.4%,CIN3+/AIS检测到11.7%,在II-P(ASC-US)中,CIN2+检测到23.4%,CIN3+和AIS检测到10.8%,在II-G(AGC宫颈内膜NOS)中,CIN2+检测为34.4%,CIN3+检测为23.4%。在HPV持续性/II-a和I组中,21%显示CIN2+,12.1%显示CIN3+和AIS,13%显示CIN2+,5.9%显示CIN3+和AIS。在HPV阴性且仅在细胞学涂片基础上进行了进一步诊断的患者中,27.9%有N2+,14.1%有CIN3和AIS。
■在新的宫颈癌筛查注册研究的初步数据的当前发现的摘要中,根据有组织的早期癌症筛查指南(OKFE-RL),我们可以证明,目标病变N3+和AIS以不显著的比例意外地频繁检测到,特别是在细胞学低风险组中。目前,我们无法回答这是否可以降低宫颈癌的发病率和死亡率,但这可能是这方面的初步迹象,并将在进一步的长期评估中进行审查。
UNASSIGNED: For the first time since 1971, new regulations were introduced for cervical cancer screening as an organized cancer screening guideline (oKFE-RL) starting 1 January 2020. From the age of 20, a cytological smear test is performed annually, and from the age of 35, so-called co-testing (cytology and test for high-risk HPVs) is performed every three years. In case of abnormalities, the algorithm is used as the basis for investigation. According to this diagnostic algorithm, even so-called low-risk groups receive early colposcopic evaluation. This approach has been heavily debated and serves as the basis for this registry
study.
UNASSIGNED: All patients who presented to the centers for a colposcopy as part of the diagnostic algorithm were included after signing an informed consent form. The following findings were obtained: Medical history, colposcopy, histology, and cytology findings, as well as possible therapies and their findings. The aim was to evaluate the frequency of the target lesions cervical intraepithelial neoplasia (CIN) 2+/CIN 3+ in the respective groups.
UNASSIGNED: A total of 4763 patients were enrolled in the
study from July 2020 to October 2022. As a referral diagnosis, HPV persistence (HPV: human papillomavirus) with group I was determined in 23.9% (1139), HPV persistence with group II-a in 2.1% (100), II-p (ASC-US) in 11.2% (535), and II-g (AGC endocervical NOS) in 1.3% (64). III-p (ASC-H) and III-g (AGC endocervical favor neoplastic) were found in 9.4% (447) and 2.2% (107), respectively, IIID1 (LSIL) in 19% (906), IIID2 (HSIL, moderate dysplasia) in 18.9% (898), IVa-p (HSIL, severe dysplasia) in 10.7% (508), IVa-g (AIS) in 0.7% (31), IVb-p (HSIL with features suspicious for invasion) and IVb-g (AIS with features suspicious for invasion) in 0.3% (15), 0.1% (6), and 7 with suspected invasion V-p (squamous cell carcinoma)/V-g (endocervical adenocarcinoma) (0.1%). In the IVa-p group (HSIL, severe dysplasia), 67.7% had CIN 2+ and 56.5% had CIN 3+, adenocarcinoma in situ (AIS), and adenocarcinoma. If the histology of the excised tissue specifically based on the colposcope findings was also evaluated, CIN 2+ was found in 79.7% of cases, and CIN 3+ in 67.3% of cases. In IIID2 (HSIL, moderate dysplasia), CIN 2+ was detected in 50.9%, and CIN 3+/AIS in 28.3%. After evaluating patients who underwent surgery immediately, this increased to 53.0% for CIN 2+ and 29.3% for CIN 3+/AIS. In IIID1 (LSIL), CIN 2+ was detected in 27.4% and CIN 3+/AIS in 11.7%, and in II-p (ASC-US), CIN 2+ was detected in 23.4% and CIN 3+ and AIS in 10.8%, and in II-g (AGC endocervical NOS), CIN 2+ was detected in 34.4% and CIN 3+ in 23.4%. In the HPV persistence/II-a and I group, 21% showed CIN 2+, and 12.1% showed CIN 3+ and AIS, and 13% showed CIN 2+ and 5.9% showed CIN 3+ and AIS. In patients who were HPV-negative and had further diagnostics performed on the basis of cytologic smear alone, 27.9% had CIN 2+, and 14.1% had CIN 3 and AIS.
UNASSIGNED: In a synopsis of the present findings of our initial data of the registry
study on the new cervical cancer screening, according to the organized early cancer screening guideline (oKFE-RL), we could show that the target lesion CIN 3+ and AIS is detected unexpectedly frequently in a not insignificant proportion, especially in the cytological low-risk group. Currently, we cannot answer whether this can reduce the incidence and mortality of cervical carcinoma, but this could be an initial indication of this and will be reviewed in further long-term evaluations.