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觵Ǩҡͧʹµͧ͵Ǩ HPV (Self-Collected HPV Testing)






觵Ǩҡͧʹµͧ͵Ǩ HPV (Self-Collected HPV Testing) 

Ҥ秹Ǫ

˵Ҥѭͧ移ҡ١ õԴ human papillomavirus (HPV) ž鹰ҹ ª͡þѲԸաûͧѹ移ҡ١Ըյҧ éմ HPV vaccine õǨѴͧ¡õǨ HPV ҡ١ (HPVtesting) 繵

õǨѴͧ移ҡ١

شʧͧõǨѴͧ移ҡ١ ͵ǨäС͹ (pre- cancerous cervical lesions) ä CIN2, CIN3 AIS ͷѡҡ͹дԹä移ҡ١ء (invasive cervical cancer) ԸաõǨ ҵðҹͧõǨѴͧ㹻ѨغѹзҧҪԷٵԹᾷ觻դй õǨԷҢͧҡ١ (cervical cytology) Ը conventional Pap smear liquid-based cytology ͧҡ㹧ҹԨ¾ҡõǨѴͧ¡õǨ HPV (HPV testing) ջԷҾ٧ Pap smear 㹡Ŵغѵԡóͧ移ҡ١ ֧աҧ͡˹觢ͧõǨѴͧ õǨԷҢͧҡ١ Ѻ HPV testing ¡ co-testing õǨ HPV testing йʵշع¡ 30 դءͧõԴ HPV ٧äդҤѭҧԹԡͧҡõǨԹԨѡ

㹻Ѩغѹ աõǨѴͧʵ觵Ǩҡͧʹµͧ (self- collected vaginal sampling) ͵Ǩ HPV ʵպҧҹդԹ դͧ ᾷǨ ҧáԸաôѧǹѧԸҵðҹ ͧҡѧբʹѺʹع ֧ԷҾ㹡Ŵغѵԡóͧ移ҡ١ §ͧѺᾷ йʵշһ֡ͧõǨѴͧԸմѧ

˵ؼŢͧǨѴͧ移ҡ١

֧ҡõǨԷ ͡õǨԷѺ HPV testing ᾷԡõʶҹҺŷ ҧáѧʵպҧҹ仾ᾷѺõǨСõǨѴͧ移ҡ١ 觾˵ؼҤѭԹ¡âҴ㨤Ǣ鹵͹ ԸաõǨ㹡ûͧѹ Դҵͧդ§ͤԴ (1,2) ֡ҵͧآҾԴջʺóաѺؤҡ÷ҧҸóآ (3) ǼšõǨԴ (4) ͧõǨ (3,4) ͧԴ¢ǹǡѺѹ (5) 繵


õǨѴͧµͧ

Ըա˹ ҨЪѭѺʵշѺõǨ (non-attendees) ʵշդԴҨѺõǨѴͧҡó㴡 (hard-to-screen women) ͡ѺõǨѴͧ移ҡ١ ͡觵Ǩҡͧʹµͧ (self-collected vaginal sampling) ʵö觵Ǩҡͧʹµͧҹɳ价ͧԺѵԡ͵Ǩ HPV §ҹšõǨҨ觡Ѻҧɳ ҧͷҧ͢¤ ԸաôѧǹҨաҧ͡˹觢ͧûͧѹ移ҡ١ͤ͡ͺʵ͡ ѺõǨѴͧҡ

ҡ֡ʵ 30-64 µͺѺԭѺõǨѴͧ移ҡ١çҺͤԹԡ աõͺѺԭǹ觵Ǩµͧ٧֧ 80 88 (6-9) §ҹ÷ǹõҧ ҧк (systematic review) ѵѷͧԹ觵ǨµͧººѺõǨºؤҡ÷ҧᾷ٧鹶֧ 2 (10) ʵշҡ觵Ǩµͧǹ˭դзѺ㹤¢ͧ鹵͹觵Ǩ ( йҢͧԸա) դ֡纹¡ҡõǨдǡ Թö繡ǹ (4,11-15)

ҧá ѧʵպҧշȹźе鹵͡觵Ǩµͧ ѧؤҡ÷ҧᾷǨѴͧҡ (5, 14, 16, 17) ˵ؼŷʵҹͺõǨѴͧµͧ ѧҨ觵Ǩ١ͧ (5,16-18) ѧҨԴѹ͡úҴ纵 (16) ѧҡõǨѧҨԴ㹪Ե (5) ҡõǨºؤҡ÷ҧᾷдǡйͶҡ (16)

ͨҡѴҤѭС˹觢ͧ觵Ǩµͧ öǨҤԴ ͧ ͹ѺõǨᾷͺؤҡ÷ҧҸóآ õԴͧͧ͢ʹлҡ١ ͧͧͧ͡ʹ ҡ١ ١ лա١ 繵

öТͧõǨѴͧµͧ

ŷ§ҹ֧öТͧ觵Ǩµͧѧդʹͧѹ¡֡ ҧ֡ҾءͧõǨ HPV ҡ纴µͧᾷդʹͧѹ٧ ҡ 90 (19) ǢͧõǨä CIN 2+ ҡ觵Ǩ纴µͧзᾷդ§ѹ 83-94 83-91 ҴѺ (11, 20, 21) ҡ§ҹ÷ǹ óҧк ʹѺʹع 觵Ǩҡ纴µͧСᾷö Ǩä CIN 2-3 §ѹ (22)


ҧáҧ֡ҾҤǢͧõǨHPV ¡ʵ觵Ǩµͧ (self-collected HPV testing) ҡҡ觵Ǩᾷ (clinician-collected HPV testing) դ㹡õǨä CIN 2+ 50 88 ººѺ 63 100 ҴѺ (13, 23, 24)


شա֡Ẻ meta-analysis ҡ 36 §ҹѤʵըҹǹ 154,556 ººҧ self-collected HPV testing Ѻ clinician-collected HPV testing clinician-collected cytology self-collected HPV testing absolute accuracy 㹡õǨä CIN2+ ä CIN 3+ ҳ 76 (95% CI :69-82) 84(95% CI :72-92) ҴѺ pooled absolute specificity 㹡õǨ ä CIN2+ 86 (95% CI : 83-89) ѵǹѷ㹡õǨä CIN2+ ä CIN 3+ ͧ self-collected HPV testing ҡ clinician-collected HPV testing ҧչҤѭ pooled relative sensitivity 㹡õǨä CIN2+ ä CIN 3+ ҡѺ 0.88(95% CI : 0.85-0.91) 0.89 (95% CI : 0.83-0.96) ҴѺ ͡ҡ relative specificity 㹡õǨä CIN2+ ͧ self-collected HPV testing ҡclinician-collected HPV testing ҧչҤѭǡѹ ѵǹҡѺ 0.96 (95% CI : 0.95-0.97) ººҧ self-collected HPV testing Ѻ clinician- collected cytology ASC-US+ cytology 繨شѴ դҡѹ㹡õǨä CIN2+ ä CIN 3+ self-collected HPV testing դеҡ ᵶ LSIL cytology 繨شѴ self-collected HPV testing դ㹡õǨä CIN2+٧ clinician-collected cytology (25)

ԸաõǨ HPV testing ռŵͤ㹡õǨä¾ҶԸ signal amplification self-collected HPV testing դǵҡ clinician-collected HPV testingԸ PCR-based HPV testing դᵡҧѹ ѧѹҨеǨѴͧ移ҡ١¡觵Ǩµͧè͡ԵѳԸ PCR-based 㹡áõǨ HPV 觨դҡѺᾷ觵Ǩ (25)

ôʵյšõǨ Self-Collected HPV Testing

ôʵ 30 ҡҷǨѴͧ移ҡ١¡觵Ǩҡͧʹµͧ͵Ǩ HPV 鹡ѺšõǨ HPV testing (26, 27)


1. Ҽź (negative HPV testing) Ǩ辺 HPV йǨѴͧء 3 ǡѺԸաûͧѹ移ҡ١ЪᨧǡѺͨҡѴͧõǨѴͧԸմѧ 㨶֧ԸշҵðҹͧõǨآҾʵդ õǨᾷ 觨öǨҤԴԢͧ к׺ѹʵ¹͡˹仨ҡõǨѴͧ移ҡ١ҧ


2. Ҽ繺ǡ (positive HPV testing) Ǩ HPV йҾᾷͷҡëѡѵԻѨ§ҧ зҡõǨҧ Ǩʹٻҡ١Ъͧʹҧ´ ҾäҡõǨԹԨµ ÷ biopsy 辺äѴਹ ҡõǨµǨԷҢͧҡ١Ҩз conventional Pap smear liquid-based cytology

2.1 ҼԷһ йǨԴ
-  õǨԷҫҷ 6 ͹ 12 ͹ ʹ١¹ŧͧҡ١ ҼԷҼԴ (≥ ASC-US) 㴤ѧ˹йǨ⤻ (colposcopy)
-  õǨ HPV testing ͤú 1 Ҽ HPV testing ź йǨѴͧء 3 Ҽ HPV testing ѧ繺ǡա ʴҹҨ persistentHPV infection йǨ¤⤻

2.2 ҼԷҼԴ (≥ ASC-US) Ǩ¤⤻ ͵Ǩäͧҡѡ

йʵշǨ
HPV

1. õǨ HPV ¤Ҽͼ˭ԧդ͹¤
2. ʵշԴ HPV

  • ʴ移ҡ١

  • ǹ˭еǨ辺ԴԷҡ١ͷҡõǨ õǨԷ СõǨ¤⤻

  • ҹҨеͧ移ҡ١ء ͡移ҡ١͹Ҥҡ (¡0.1)

  • ǹ˭ҡ 80-90 ͧõԴͨͧ

  • ҾᾷѺõǨԴҧ 觶դԴԴ͹秨Ǩѡҡ͹С

3. դ繷еͧǨ HPV 㹼еǨ HPV  (ҳ 60 ҹ) ѡǨ辺äͧѡ

ػ

觵Ǩҡͧʹµͧ͵Ǩ HPV ѧԸҵðҹͧõǨѴͧ移ҡ١ ԸաõǨѧʵ 30 ҡաҧ͡˹觢ͧõǨѴͧ移ҡ١ʵշդԹʧؤҡ÷ҧᾷҡõǨ ǨѴͧ 觤ҴҨЪ ͺͧõǨѴͧ੾ʵշդ֡ѧ 㹾鹷դͺҧáйʵդǡѺͨҡѴͧԸաõǨ ùԸաõǨѴͧѧһء㹻 ա֡ ǡѺѺ ö㹡õǨä͹移ҡ١ СŴغѵԡóͧ移ҡ١

͡ҧԧ

  1. Kritpetcharat O, Suwanrungruang K, Sriamporn S, Kamsa-Ard S, Kritpetcharat P, Pengsaa P. The coverage of cervical cancer screening in Khon Kaen, northeast Thailand. Asian Pac J Cancer Prev 2003;4:103-5.

  2. Thanapprapasr D, Deesamer S, Sujintawong S, Udomsubpayakul U, Wilailak S. Cervical cancer screening behaviours among Thai women: results from a cross-sectional survey of 2112 healthcare providers at Ramathibodi Hospital, Thailand. Eur J Cancer Care (Engl) 2012;21:542-7

  3. Darlin L, Borgfeldt C, Forslund O, Hénic E, Hortlund M, Dillner J, et al. Comparison of use of vaginal HPV self-sampling and offering flexible appointments as strategies to reach long-term non-attending women in organized cervical screening. J Clin Virol 2013;58:155-60.

  4. Scarinci IC, Litton AG, Garcés-Palacio IC, Partridge EE, Castle PE. Acceptability and usability of self-collected sampling for HPV testing among African-American women living in the Mississippi Delta. Womens Health Issues 2013;23:e123-30.

  5. Szarewski A, Cadman L, Ashdown-Barr L, Waller J. Exploring the acceptability of two self-sampling devices for human papillomavirus testing in the cervical screening context: a qualitative study of Muslim women in London. J Med Screen 2009;16:193-8.

  6. Léniz J, Barriga MI, Lagos M, Ibáñez C, Puschel K, Ferreccio C. HPV vaginal self-sampling among women non-adherent to Papanicolaou screening in Chile. Salud Publica Mex 2013;55:162-9.

  7. Khanna N, Mishra SI, Tian G, Tan MT, Arnold S, Lee C, et al. Human papillomavirus detection in self-collected vaginal specimens and matched clinician-collected cervical specimens. Int J Gynecol Cancer 2007;17:615-22.

  8. Safaeian M, Kiddugavu M, Gravitt PE, Ssekasanvu J, Murokora D, Sklar M, et al.Comparability of self-collected vaginal swabs and physician- collected cervical swabs for detection of human papillomavirus infections in Rakai, Uganda. Sex Transm Dis 2007;34:429-36.

  9. Nobbenhuis MA, Helmerhorst TJ, van den Brule AJ, Rozendaal L, Jaspars LH, Voorhorst FJ, et al. Primary screening for high risk HPV by home obtained cervicovaginal lavage is an alternative screening tool for unscreened women. J Clin Pathol 2002;55:435-9.

  10. Racey CS, Withrow DR, Gesink D. Self-collected HPV testing improves participation in cervical cancer screening: a systematic review and meta- analysis. Toronto Can J Public Health 2013;104:e159-66.

  11. Dijkstra MG, Heideman DA, van Kemenade FJ, Hogewoning KJ, Hesselink AT,Verkuijten MC, et al. Brush-based self-sampling in combination with GP5+/6+-PCR-based hrHPV testing: high concordance with physician-taken cervical scrapes for HPV genotyping and detection of high-grade CIN. J Clin Virol 2012;54:147-51.

  1. Igidbashian S, Boveri S, Spolti N, Radice D, Sandri MT, Sideri M. Self-collected human papillomavirus testing acceptability: comparison of two self- sampling modalities. J Womens Health (Larchmt). 2011;20:397-402.

  2. Szarewski A, Cadman L, Mallett S, Austin J, Londesborough P, Waller J, et al. Human papillomavirus testing by self-sampling: assessment of accuracy in an unsupervised clinical setting. . J Med Screen 2007;14:34-42.

  3. Anhang R, Nelson JA, Telerant R, Chiasson MA, Wright TC Jr. Acceptability of self-collection of specimens for HPV DNA testing in an urban opulation. J Womens Health (Larchmt) 2005;14:721-8.

  4. Dzuba IG, Díaz EY, Allen B, Leonard YF, Lazcano Ponce EC, Shah KV, et al. The acceptability of self-collected samples for HPV testing vs. the pap test asalternatives in cervical cancer screening. J Womens Health Gend Based Med 2002;11:265-75.

  5. Howard M, Lytwyn A, Lohfeld L, Redwood-Campbell L, Fowler N, Karwalajtys T. Barriers to acceptance of self-sampling for human papillomavirus across ethnolinguistic groups of women. Can J Public Health 2009;100:365-9.

  6. Kahn JA, Bernstein DI, Rosenthal SL, Huang B, Kollar LM, Colyer JL, et al. Acceptability of human papillomavirus self testing in female adolescents. Sex Transm Infect 2005;81:408-14.

  7. Forrest S, McCaffery K, Waller J, Desai M, Szarewski A, Cadman L, et al. Attitudes to self-sampling for HPV among Indian, Pakistani, African- Caribbean and white British women in Manchester, UK. J Med Screen 2004;11:85-8.

  8. Darlin L, Borgfeldt C, Forslund O, Hénic E, Dillner J, Kannisto P. Vaginal self-sampling without preservative for human papillomavirus testing shows good sensitivity. J Clin Virol 2013;56:52-6.

  9. Wu R, Du H, Belinson SE, Pretorius RG, Zou J, Yang B, et al. Secondary screening after primary self-sampling for human papillomavirus from SHENCCAST II. J Low Genit Tract Dis 2012;16:416-20.

  10. Hatla N, Dar L, Patro AR, Kumar P, Kriplani A, Gulati A, et al. Can human papillomavirus DNA testing of self-collected vaginal samples compare with physician-collected cervical samples and cytology for cervical cancer screening in developing countries? . Cancer Epidemiol 2009;33:446-50.

  11. Stewart DE, Gagliardi A, Johnston M, Howlett R, Barata P, Lewis N, et al; HPV Self-collection Guidelines Panel. Self-collected samples for testing of oncogenic human papillomavirus: a systematic review. . J Obstet Gynaecol Can 2007 ;29:817-28.

  12. Zhao FH, Lewkowitz AK, Chen F, Lin MJ, Hu SY, Zhang X, et al. Pooled analysis of a self-sampling HPV DNA Test as a cervical cancer primary screening method. J Natl Cancer Inst 2012 8;104:178-88.

  13. Belinson JL, Qiao YL, Pretorius RG, Zhang WH, Rong SD, Huang MN, et al. Shanxi Province cervical cancer screening study II: self-sampling for high-risk human papillomavirus compared to direct sampling for human papillomavirus and liquid based cervical cytology. Int J Gynecol Cancer 2003;13:819-26.

  14. Arbyn M. HPV testing on cervical samples taken by the women versus HPV testing or cytology on specimen taken by a clinician: A meta-analysis of the accuracy to detect cervical cancer precursors. In: Proceedings of the EUROGIN 2013, November 3-6,2013, Florence, Italy (abstract SS 7-2).

  15. Dijkstra M, van Niekerk D, Rijkaart D, van Kemenade FJ, Heideman DA, Snijders P,et al.Primary hrHPV DNA testing in cervical cancer screening: how to manage screen positive women? A POBASCAM Trial sub study. Cancer Epidemiol Biomarkers Prev 2013 [Epub ahead of print] PMID:23733907

  16. Ronco G, Dillner J, Elfström KM, Tunesi S, Snijders PJ, Arbyn M, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet 2013 [Epub ahead of print] doi.org/10.1016/S0140-6736(13)62218-7 




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