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Please share your oppinion:
请分享你的观点
Recently I noticed this topic in another cytology website in China. Let us have a discussion here.
最近我在另一个中国的细胞学网站中注意到这个主题。让我们一起在这里讨论。
1. Are all cervical carcinoma related to HPV infection?
所有的宫颈癌都是由HPV导致的吗?
2. When the women or who should have high risk HPV (hrHPV) testing?
那些女性需要或者什么时候做高危HPV检测呢?
3. What methods to detect hrHPV do you used in your hospitals?
你们医院用的是那种方法检测高危HPV?
4. What should the women do if she has positive hrHPV result?
如果她的高危HPV的结果是阳性的,她们该怎么办?
5. hrHPV testing should be performed for women with AGC?
细胞学结果为AGC的女性应该进行高危的HPV检测吗?
6. Any question, experience or oppinion you have, please share or discuss.
所有以上问题,就你个人的观点或经验来分享和讨论吧。
We as pathologists should know some basic information about HPV even though HPV testing might not be oerformed in your hospital, or the patients might not be able to pay for the test.
即使HPV检测在你们医院没有开展或病人没有经济能力支付这项检测。我们做为病理学医生应该知道一些关于HPV的基本知识。
以下是引用城北在2009-4-7 13:01:00的发言:
作为病理医生我们不建议病人作HPV检测筛查,推荐HPV筛查检测的专家大多是妇产科医师,我们这里也是。妇产科医师坚持要为病人作HPV检测,需要相应的科室开展这项常规工作。在国内凯普的导流杂交和亚能的膜杂交技术都是国产的分型检测HPV的技术。能检测20多种HPV并且分型(在这一点上优于HC2),有文章指出,这两种方法敏感性要比HC2差一些。 我不建议做HPV筛查,即如上所言,查出来阳性甚或hrHPV阳性,我们没有什么好的办法,还是要去做细胞学、HPV检测的随诊。精神压力和经济支出增加不少。 不过对于细胞学检测为ASC-US的病例,作HPV检测的意义还是比较大的,有助于明确其意义。 另外,(前面我也说过)听说现在可以检测HPV感染状态(致癌、非致癌),如果是某种(不管哪一型)HPV致癌性感染,那么发展为癌的风险更大。就是以前所说的CIN2、3也有相当部分有自限性,不进展为癌,但是如果检测出HPV致癌性感染,就会发展为癌。如果是这样,知道治疗的意义就大了。请教各位,这个传说的真实性和原理。 |
In the USA HC2 is FDA-approved HPV detection method for liquid-based Pap. HC2 detects 13 types of high risk HPV. There are more than 100 types of HPV and about 40 types can cause infect human. If types of HPV can cause cancer they are called high risk HPV. Recently some other types besides the 13 types detected by HC-2. However they account for rare cases. From Dr. Yu's table you can know most cases of CIN2/3 will not develope into cancer. Almost all cases of CIN2/3 are caused by high risk HPV infection. In fact most of CIN2/3 are caused by HPV16 and HPV18.
Also women infected with HPV 16, 18 are more easy to develope high grade dyspalsia and cancer compared the cases with other high risk HPV infection. This is why some people suggest to detect HPV 16 and 18 only.
以下是引用法师在2009-4-5 22:43:00的发言:
在确切的治疗方法出现之前,HPV 的检测弊大于利,因为即使知道了HPV 感染能做什么呢?相反会给患者带来焦虑:1、患者个人的担心;2、来自社会的压力;3、来自配偶的不信任等。精神上的焦虑会给健康更大的伤害。不过社会上很多所谓的医院却很善于在这个问题上做文章,各种治疗方法层出不穷。 据资料HPV 感染与宫颈癌相关,但反过来并不是所有感染HPV的都一定会发展成癌吧,HPV感染向癌发展,这中间总有一个过程,而且这个过程也不可能是短暂的,总应该是一个渐进的过程,因此常规的有规律的细胞学检查完全可以掌握它的发展程度,如果形态学上无进展,则可不予理睬,如果达到了手术指征,则手术治疗。 |
DR. 法师,
Your statement is very good. I can know you are a very considerate clinical staff and have a solid knowledg on HPV infection. 100% agree with you that most women with HPV infection will not have high grade dysplasia and only a few may develope cancer even without any treatment. We do not need to do HPV test for all women now.
Do you think HPV testing can be useful for women with atypical squamous cell Pap? I am interested to know your comment.