子宮頸癌篩檢工具之評估

Assessing the Performance of Two Cervical Cancer Screening Methods

林幼平(You-Ping Lin) ； 郭旭崧(Hsu-Sung Kuo) ； 謝長堯(Chang-Yao Hsieh) ； 黃文哲(Thomas W. Huang) ； 陳建仁(Chien-Jen Chen)

《中華公共衛生雜誌》 15卷5期 (1996/10) Pp. 411-424

https://doi.org/10.6288/CJPH1996-15-05-02

摘要

子宮頸癌高居臺灣地區女性癌症發生率之第一位。臺灣地區歷年子宮頸癌死亡車並未因實施子宮頸癌篩檢而有明顯下降，除受檢率偏低而外，篩檢工具因效度不佳以致未達其最大效用亦可能是重要的原因。本研究旨在評估子宮頸抹片及子宮頸攝影兩種子宮頸癌篩檢工具，並進而探討決定篩檢效度之可能因子“本所究利用子宮頸林片及子宮頸攝影在臺灣地區七個鄉鎮市的10,628名婦女進行子宮頸癌篩檢，兩種篩檢中任一結果為陽性者即予以切片確診。結果發現子宮頸抹片在子宮頸癌前低度病變及高度病變之「最高敏感度」分別為49.4%、94.2%，特異度為99.7%、98.9%，陽性預測值為89.9%、57.0%。子宮頸攝影之「最高敏感度」則分別為70.7%、45.9%，特異度為98.5%、94.8%，陽性預測值為74.7%、13.5%。合併使用兩種工具進行平行檢定後低度及高度病變之教感度分別為85.3%、96.6%，特異度為98.0%、93.5%，陽性預測值為79.9%、28.8%。子宮頸抹片及子宮頸攝影之檢體品質對於篩檢工具效度並無顯著影響，但年齡、採檢時間等個案特性與採檢狀況則和篩檢工具之效度有關。

關鍵字

子宮頸癌 ； 子宮頸抹片 ； 子宮頸攝影 ； 敏感度

並列摘要

Cervical cancer is the leading cancer for women in Taiwan. The age-adjusted incidence rate of cervical cancer was as high as 33.5 per 100,000 in Taiwan area, 1987. There are evidences suggesting early screening can reduce incidence and mortality of cervical cancer. However, the decline in cervical cancer mortality in Taiwan has not been compatible with those observed in other countries. Low participation rate of screening is a major reason for high mortality. Nevertheless, it is also likely the screening tool was not employed in an effective and accurate way. This study aimed to evaluate the validity of two cervical cancer screening tools, Pap smear and cervicography, and to explore factors affecting the validity. There were a total of 10,628 women from seven townships in Taiwan received cervical cancer screening by Pap smear and cervicography. Confirmation by colposcopy-guided biopsy was carried out for those who were suspected to have cervical cancer or precancerous lesion found by smear and/or cervicography.
The maximal sensitivity of Pap smear for LSIL (low-grade squamous intraepithelial neoplasia) and HSIL (high-grade squamous intraepithelial neoplasia) were 49.4% and 94.2%, respectively. The specificity of Pap smear for LSIL and HSIL were 99.7% and 98.9%, respectively. The positive predictive values of Pap smear were 899% and 57.0% for LSIL and HSIL, respectively. The maximal sensitivity of cervicography for LSIL and HSIL were 70.7% and 45.9%. The specificity of cervicography for LSIL and HSIL were 98.5% and 94.8%. The positive predictive values of cervicography for LSIL and HSIL were 74.7% and 13.5%, respectively. The combination of Pap smear and cervicography increased the maximal sensitivity for LSIL and HSIL up to 85.3% and 96.6%. Whereas the specificity slightly decreased to 98.0% and 93.5%. The positive predictive values for the combined screening were 79.9% and 28.2%, respectively. The validity of Pap smear and cervicography was not affected by sampling quality, but was affected by subject characteristics and sampling conditions.

並列關鍵字

cervical cancer ； Pap smear ； cervicography ； sensitivity