在一个发展中国家利用细胞学、子宫颈造影术和醋酸试验筛查子宫颈肿瘤。
Screening for cervical neoplasia in a developing country utilizing cytology, cervicography and the acetic acid test.
作者信息
Cronjé H S, Cooreman B F, Beyer E, Bam R H, Middlecote B D, Divall P D
机构信息
Department of Obstetrics and Gynecology, University of the Orange Free State, Bloemfontein, South Africa.
出版信息
Int J Gynaecol Obstet. 2001 Feb;72(2):151-7. doi: 10.1016/s0020-7292(00)00382-9.
OBJECTIVE
To compare three screening tests for cervical neoplasia.
METHOD
Women (6301) were screened simultaneously with cytology, cervicography and the acetic acid test (AAT). Biopsies were taken from the acetowhite lesions and every fifth seemingly normal cervix. Positive cases (both at screening and histology) were referred for colposcopy. The histology results served as the golden standard.
RESULTS
Cytology was positive in 1.7% of cases, cervicography in 10.7% and the AAT in 17.8%. The sensitivity of cytology was 19.3%, of cervicography 41.8% and the AAT 49.4%. Corresponding specificities were 99.3%, 78.8% and 48.5%. In 23% of biopsies showing cervical intraepithelial neoplasia (grade I--III), all three screening tests were negative. By combining the three tests, a sensitivity of 76.9% was achieved.
CONCLUSION
The sensitivity of cytology alone is not great enough for implementing as a screening test in a developing country where screening programs are often inadequate. Screening with a combination of tests, once or a few times per woman's life, is a more acceptable alternative since it allows for less screening events without sacrifying sensitivity.
目的
比较三种宫颈癌前病变筛查试验。
方法
对6301名女性同时进行细胞学检查、宫颈造影和醋酸试验（AAT）。从醋酸白病变处及每五个看似正常的宫颈处取活检组织。筛查及组织学检查均呈阳性的病例转诊至阴道镜检查。组织学检查结果作为金标准。
结果
细胞学检查阳性率为1.7%，宫颈造影为10.7%，AAT为17.8%。细胞学检查的灵敏度为19.3%，宫颈造影为41.8%，AAT为49.4%。相应的特异度分别为99.3%、78.8%和48.5%。在23%显示宫颈上皮内瘤变（I - III级）的活检组织中，所有三种筛查试验均为阴性。通过联合三种试验，灵敏度达到76.9%。
结论
在筛查项目往往不完善的发展中国家，仅细胞学检查的灵敏度不足以作为一种筛查试验实施。在女性一生中进行一次或几次联合试验筛查是一种更可接受的选择，因为这样可以减少筛查次数而不牺牲灵敏度。
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