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- 你认为HPV 检测有必要吗?
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。
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本帖最后由 于 2009-04-06 09:33:00 编辑
×参考诊断
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本帖最后由 于 2009-04-14 12:01:00 编辑
如果细胞学为明确病变（HSIL或LSIL），或活检也能明确诊断，则不需要检测HPV。
You are right.
More than 80% LSIL and more than 90% (aaverage 95%) HSIL cases are high risk HPV positive detected by HC2. This is why HPV testing should not be done for these women. I know some medical school hospitals in China detect HPV for all women with abnormal Pap including LSIL and HSIL. This really wastes patients' money. I feel pain for these women especially for those who pay their own money for the testing. As pathologists we need to let clinical physicians know that. We have the responsibility.
By the way, how much for one convention Pap, LBC, and HC2 HPV testing?
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Some Chinese national organizations should design some large trials. High risk HPV DNA in larger number of LBC specimens is detected by HC2 and some detection products made by China. Then comparison of sensitivity and specificity. I totally agree that we should have our own products.
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本帖最后由 于 2009-04-26 05:00:00 编辑
Recently I contacted a Professor of gynecologist in a medical school hospital in China and know that all women with atypical Pap including LSIL and HSIL would have HPV testing in her hospital. Do you think this is standard patient care? If not, do you know why?
Some people told me that in China the adventisment said: HPV testing can detect cervical cancer and all women who have sexual activity should have HPV testing.
Do you think it is true? why?
| 以下是引用wq_9603在2009-4-26 8:08:00的发言： 赵老师最后提到的这种现象，正好印证了我前面回复的一个帖子中提到的：患者和医护人员之间存在知识和信息的不对称，患者的所谓知情权只是表面现象，患者到了医院之后根本没有所谓的选择权，要选的只是：治疗还是不治疗？至于治疗是否考虑了他的经济水平、对其生活质量的影响等，他根本无从知晓…… |
Thank you, Dr. wq-9603. I noticed that you have many good comments in this website.
Could you explain more to your statement above.
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本帖最后由 于 2009-05-02 11:23:00 编辑
Excellent discussion here initiated by Dr. Zhao, I just would like to add more fuel to the fire. In November 2007, I attended the International HPV meeting held in Beijing. I had extensive conversation with Dr. Mark Stoler (a leading expert cytologist on Pap test) and his friends of world experts on Gynecologic Oncology, their opinions are at least using HPV HC2 test as the primary screening test to replace Pap test, Pap test may be the secondary test or even replaced totally by other test. They said that I would not see any Paps in the near future with this proposed guidline and the HPV vacine. What's your thoughts on this?
这是赵博士发起的出色讨论,我只想“火上浇油”。2007年11月，我参加了在北京举行的国际HPV会议。我同Mark Stoler 博士（一个在巴氏试验领域领先的细胞学专家）和他的朋友们（世界妇科肿瘤专家）进行了广泛的交流。他们的意见是至少使用HPV HC2检测作为主要筛查试验以取代巴氏试验。巴氏试验可能是次要的试验，甚至完全被其他试验取代。基于他们的提议指南和HPV疫苗，在不久的将来，我们将看不到巴氏涂片。您对此有何想法？
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本帖最后由 于 2009-04-30 01:41:00 编辑
The above paper was out just in April 1. Dr. Austin (did the main work) and I analysed their data in details and noted that the authors manipulated the data and obtained the conclusion that one HPV screening is better than one cytology screening. We think it is abiase. The paper is agaist Pap cytology.
上述文章是刚刚发表于4月1日。Austin 博士（做了主要工作）和我在分析他们数据的细节时注意到作者操纵了数据并获得的结论是：HPV筛查优于细胞学筛查。我们认为这是可悲的 。该文章是against子宫颈细胞学检查。
In fact, the study acknowledged that the positive predictive value (PPV) for detecting CIN 2-3 was 19.3% in the cytologic-testing group, higher than 11.3% in the HPV-testing group, and study results indicate that essentially the same numbers of cervical cancers were detected after positive screening test results in the cytology arm (88) as in the HPV arm (87). Cervical cancer detection rates were 0.344% in the cytologic-testing group and 0.321% in the HPV-testing group. However the authors can obtain different conclusion based on the results.
事实上，这项研究在检测CIN2-3获得的阳性预测值（ PPV ）中细胞学为19.3%， 高于11.3 ％的HPV检测组。研究结果表明，基本上是相同的宫颈癌检测的筛查数据，检测的阳性结果在细胞学为（ 88 ）在HPV为（ 87 ）。宫颈癌检出率在细胞学检测组和HPV检测组分别为0.344 ％和0.321 ％。然而，基础上的结果作者可以得到不同的结论。
Now most large studies are company related or finally related. We write a commentary titled as " Test group biases and ethical issues mar New England Journal of Medicine articles promoting HPV screening for cervical cancer in rural
现在大多数大型研究都与公司利益相关或最后公司利益相关。对这一文章我们写一篇“新英格兰医学杂志发表的文章中在印度农村地区进行HPV筛查宫颈癌的试验组的偏见和伦理问题”评论，今日并递给细胞杂志（线上杂志）。希望它可以快速发表。
"Mar" is a fancy word which means ruin, spoil, spoil, blight.
I just learn this word.
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本帖最后由 于 2009-05-01 23:25:00 编辑
I hope these kinds of trials will not be performed in China. The companies and researchers like the population in China, contrysides. We welcome some good trials and should against some trials with final purpose.
我希望这种类型的实验不要在中国进行。这些公司和研究机构看中的是中国农村广大的人口。我们欢迎一些好的科研实验和反对一些操控最终目标的科研实验。
I guess that HPV DNA test may be more profitable for the hospitals than the Pap test. Is that the case in China?
I just would like to make few comments. When we talk about HPV positive, AGE is a big factor, as Dr. Yu's previous post, in older women, HPV has a very high positive predictive valure for cervical squamous dysplasia, on the other hand, in younger (<30 years old) women, its PPV is poor. So, doing HPV DNA test as the primary screen NOW in all women age groups is not cost effective.
What if in the near future, a very cheap and good HPV test method is developed, in stead of 320 CNY, it lowers down to 40 CNY, is Pap test at that time threatened?
| 以下是引用cqzhao在2009-4-29 4:55:00的发言： Not all women with HPV infection will show CIN1 cytology. Based on the Dr. Yu's table we know only less than 1% CIN1 will progress to invasive ca if no any treatment. In other words most of women with HPV infection will be fine and will not develope invasive ca. Generally speaking it takes long term from CIN1 -invasive ca. I do not think it is good idea to check all women for HPV infection even though the testing is cheap in future. We need to consider the social and psychologic effect, until we have effective treatment for HPV infection. |
目前国内有的在做FISH检测，可以预测出具体某个CIN1的病例发展到CIN3-浸润癌的风险大小。但是价格太昂贵了……
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