Jeronimo Jose, Morales Orlando, Horna Jorge, Pariona José, Manrique Javier, Rubiños Jorge, Takahashi Rina
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, National Institutes of Health, Rockville, Maryland, USA.
Rev Panam Salud Publica. 2005 Jan;17(1):1-5. doi: 10.1590/s1020-49892005000100001.
To assess visual inspection with acetic acid (VIA) as a screening tool for use in a well-equipped health center in Peru, to evaluate VIA as an alternative or adjunct to the Papanicolaou (Pap) smear, and to determine if VIA can play a role in settings other than low-resource ones.
This was a prospective study of 1 921 asymptomatic women living in Lima, Peru, carried out in 1999 and 2000. The study was performed at a cancer center equipped with the latest-generation technology and highly trained oncologists. The women underwent a complete clinical evaluation, including a Pap smear and VIA. Participants with any positive test were referred for colposcopy and biopsy.
More women tested positive by VIA than on the Pap smear (6.9% vs. 4.2%; P = 0.0001). There were 35 women with histologic cervical intraepithelial neoplasia grade 1 (CIN 1); of these, 15 were detected by Pap and 20 by VIA (P = 0.4). A diagnosis of CIN 2 or 3 (CIN 2-3) was confirmed in a total of 13 cases; Pap detected 5 of the cases and VIA 11 of the cases (P = 0.06). The positive predictive value for detection of CIN 2+ was 8.3% for VIA and 6.3% for Pap (P = 0.5). Most importantly, while only 2.3% of patients with a positive VIA were lost to follow-up before colposcopy, that was true for 26.3% of the women with a positive Pap smear (P < 0.0001).
VIA is useful for detection of precursor lesions of cervical cancer not only in low-resource settings but also in well-equipped health centers and cancer centers. In these non-low-resource settings, VIA has a positive predictive value comparable to the conventional Pap smear, but it is more likely to achieve earlier diagnosis, follow-up, and treatment than cytology-based screening.
评估在秘鲁设备完善的健康中心使用醋酸肉眼观察法（VIA）作为筛查工具，评价VIA作为巴氏涂片检查的替代方法或辅助方法，并确定VIA是否能在资源丰富的环境中发挥作用。
这是一项针对1999年和2000年居住在秘鲁利马的1921名无症状女性的前瞻性研究。该研究在配备了最新技术且有训练有素的肿瘤学家的癌症中心进行。这些女性接受了包括巴氏涂片检查和VIA在内的全面临床评估。任何一项检测呈阳性的参与者都被转诊进行阴道镜检查和活检。
VIA检测呈阳性的女性多于巴氏涂片检查呈阳性的女性（6.9%对4.2%；P = 0.0001）。有35名女性组织学诊断为宫颈上皮内瘤变1级（CIN 1）；其中，巴氏涂片检查检测出15例，VIA检测出20例（P = 0.4）。总共确诊了13例CIN 2或3级（CIN 2-3）病例；巴氏涂片检查检测出5例，VIA检测出11例（P = 0.06）。VIA检测CIN 2+的阳性预测值为8.3%，巴氏涂片检查为6.3%（P = 0.5）。最重要的是，VIA检测呈阳性的患者在阴道镜检查前失访的比例仅为2.3%，而巴氏涂片检查呈阳性的女性中这一比例为26.3%（P < 0.0001）。
VIA不仅在资源匮乏地区，而且在设备完善的健康中心和癌症中心，对于检测宫颈癌前病变都很有用。在这些非资源匮乏的环境中，VIA的阳性预测值与传统巴氏涂片检查相当，但与基于细胞学的筛查相比，它更有可能实现早期诊断、随访和治疗。
