Blumenthal P D, Gaffikin L, Chirenje Z M, McGrath J, Womack S, Shah K
Department of Obstetrics and Gynecology, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
Int J Gynaecol Obstet. 2001 Jan;72(1):47-53. doi: 10.1016/s0020-7292(00)00329-5.
To test whether the performance of visual inspection using acetic acid (VIA) could be improved through adjunctive testing and to determine whether the combination of visual inspection of the cervix and HPV testing could prove useful for identifying those at highest risk of cervical precancer.
Between October 1995 and August 1997, 2199 women willing to be screened for cervical cancer in peri-urban clinics in Harare, Zimbabwe received VIA, Pap smear and HPV as screening tests. The presence or absence of (pre)cancer was confirmed via colposcopy with biopsy as indicated for >97% of all women. Computerized simulations of sequential testing scenarios provided estimates of the joint (net) test qualities of different paired combinations of the three tests and allowed for comparisons with the individual test qualities.
Using HGSIL/CIN II-III as the reference threshold of disease, the net sensitivity and specificity of VIA and HPV when used sequentially were 63.6 and 81.9%, respectively, compared to 43.3 and 91%, respectively, when Pap smears were followed by HPV testing. VIA followed by the Pap smear yielded a net sensitivity of 37.5% and net specificity of 94.3%.
For programs with limited resources but with the capacity for HPV testing, sequential testing involving the use of VIA followed by HPV could yield fewer false positives than the use of VIA alone at a cost of relatively few additional false negatives.
测试通过辅助检测能否提高使用醋酸的肉眼观察法（VIA）的性能，并确定宫颈肉眼观察与HPV检测相结合是否有助于识别宫颈癌前病变风险最高的人群。
1995年10月至1997年8月期间，在津巴布韦哈拉雷的城郊诊所，2199名愿意接受宫颈癌筛查的女性接受了VIA、巴氏涂片检查和HPV检测作为筛查手段。超过97%的女性通过阴道镜检查及活检确定是否存在（癌前）病变。对序贯检测方案进行计算机模拟，以估计这三项检测不同配对组合的联合（净）检测质量，并与各项检测质量进行比较。
以高度鳞状上皮内病变/宫颈上皮内瘤变II - III级作为疾病参考阈值，序贯使用VIA和HPV时，净敏感性和特异性分别为63.6%和81.9%，而先进行巴氏涂片检查再进行HPV检测时，净敏感性和特异性分别为43.3%和91%。先进行VIA再进行巴氏涂片检查，净敏感性为37.5%，净特异性为94.3%。
对于资源有限但具备HPV检测能力的项目，先使用VIA再进行HPV的序贯检测可能比单独使用VIA产生更少的假阳性结果，代价是额外产生相对较少的假阴性结果。
