Hubei Zhong Shan Hospital, P.R. China
Title: Population-based study of automated DNA image cytometry as a screening method for cervical cancer in rural areas of China
Sun Xiaorong works in Hubei Zhong Shan Hospital, P.R. China.
Introduction: Worldwide, cervical cancer is the third most common cancer among women and over 85% of cervical cancer
occurs in developing countries. It is estimated that China accounts for 14% of the world’s annual incidence of cervical cancer
and 12% of the world’s annual mortalities related to cervical cancer. Th ere is no national screening program for cervical cancer
in China. Screening remains opportunistic and is centered in large cities. 60% of the Chinese population resides in rural areas,
where 90% of incidents of cervical cancer cases might occur. Th ese areas lack suffi cient cytopathologists and cytotechnicians to
interpretate Pap cytology specimens. Th e purpose of this study is to compare automated DNA Image cytometry (DNA ICM)
and liquid-based cytology (LBC) as primary screening methods for cervical cancer and precancerous lesions.
Materials and methods: Our population-based screening program was made possible by the Wuhan government. 15 rural
areas in Wuhan were selected for the study. Cervical samples from the women were collected by a brush and placed into a
cytofi xative solution. Two slides were prepared from each sample using a cytospin. Th e Papanicolaou method was used to stain
one slide for manual cytology examination based on TBS criteria, while the other slide was stained with Feulgen for automated
DNA ICM analysis. Cervical histological biopsies were performed on women whose Pap tests showed LSILs and above and/or
when automated DNA ICM analyses reported at least 3 cells with abnormal aneuploidy (≥5C).
Results: A total of 181,455 women from rural areas in Wuhan were screened using both LBC and automated DNA ICM.
Th e mean age of the women was 39 years, and the age range was 35 to 45 years. We compared the results of automated DNA
ICM to those of LBC. Th e rate of positive detection by automated DNA ICM was 5.4% in women with negative Pap tests and
98.7% in women with HSIL Pap tests. 1,498 women had cervical histological follow-ups. Of these women, CIN1+ lesions were
diagnosed in 525 cases (35.1%), including 7 cases of invasive cervical cancer (0.47%). Th e correlation between histological
fi ndings and LBC and automated DNA ICM results is being analyzed.
Th e preliminary results suggest that automated DNA ICM might be used in countries where it would be diffi cult to introduce population based cervical cancer screening due to the lack of cytopathologists and cytotechnologists.