子宫颈癌筛查方法学研究【精品】.pptVIP

;内容提要;中国子宫颈癌流行背景;我国子宫颈癌筛查的现状;The new government-sponsored program is a step towards provision of universal breast and cervical cancer screening nationwide, although with an estimated 500 million women in rural China the public health challenge is substantial. This is the first time China’s Government has proposed to gradually widen access to public health services so that women in rural China are included. This admirable step needs to be followed by development of more appropriate health-care policies to achieve access to health-care services for all. The success of this health-care program will need to be evaluated carefully over a sustained period, and could provide a good model for other middle-income countries to follow.;癌症早诊早治的条件;子宫颈癌筛查——传统巴氏涂片 ;薄层液基细胞学（LBC）;第二代杂交捕获试验HPV检测系统(HC2);醋酸/碘染色肉眼观察(VIA/VILI);筛查方法的评价指标;研究内容和方法;;筛查流程;一般特征;;不同截断值下医生取样和妇女取样的HC2检测;HC2检测的ROC曲线：医生取样和自我取样 以CIN 2+为病例;;;ROC曲线;检测阳性率和最终诊断;不同年龄组检测方法的准确性;不同年龄组的检测阳性率;VIA总体灵敏度较低，但特异度较高，增加VILI检查有助于提高筛查的灵敏度，VIA/VILI对50岁以上的妇女敏感性较差； VIA对设备设施的要求低，现阶段可用于在无法开展HPV和细胞学检测的经济欠发达地区，但需要加以规范化的技术培训； 如单独以肉眼观察为初筛方案，为减少漏诊，可考虑放宽筛查阳性标准，或增加筛查频率。 ; HPV DNA检测（HC-2）具有很高的灵敏度和较好的特异度，客观性好，不同实验室间可重复性强; HPV DNA检测的灵敏度不随年龄变化, 35岁以下中国妇女HPV检测的特异度并不低; 自我取样HPV检测的灵敏度虽低于医生取样HPV检测，但仍高于细胞学方法； HPV DNA检测的截断值上升至2.0pg/mL时，阴道镜的转诊率降低，且灵敏度无显著下降。 ;子宫颈癌筛查前景;致谢;fVq(B6MhWs)D8NjYu+EaPl#v1GbRm$x2IdTo%z4KfUq*A6LhWr)C8NiYt+E9PkZv0GbQm!x2HdSo%y4JeUp*A5LgWr(C7NiXt-D9OkZu0FbQl!w2HcSn$y3JeTpA5KgVr(B7MhXs-D8OjZu+FaPl#w1GcRn$x3IeToz4KfVq*B6MhWs)D8NjYt+EaPk#v1GbRm$x2IdSo%z4JfUq*A6LhWr)C7NiYt-E9PkZv0GbQm!w2HdSn%y4JeUp*A5LgVr(C7MiXt-D9OkZu0FaQl!w1HcSn$y3JeTpz5KgVq(B7MhXs-D8OjYu+FaPl#w1GcRn$x3IdToz4KfVq*B6MhWs)C8NjYt+EaPk#v1GbRm!x2IdSo%z4JfUp*A6LgWr)C7NiYt-E9OkZv0FbQm!w2HdSn%y3JeUpA5LgVr(C7MiXs-D9OjZu0FaQl!w1HcRn$y3IeTpz5KgVq(B6MhXs)D8OjYu+FaPl#v1GcRm$x3IdToz4KfUq*B6LhWs)C8NjYt+E9Pk#v0GbRm!x2IdSo%y4JfUp*A6LgWr)C7NiXt-E9OkZv0FbQm!w2HcSn%y3JeUpA5LgVr(B7MiXs-D9OjZu+FaQl#w1HcRn$y3IeToz5KfVq(B6MhXs)D8NjYu+EaPl#v1GcRm$x2IdTo%z4KfUq*B6LhWr)C8NiYt+E9Pk#v0GbQm!x2HdSo%y4