El-Shalakany Amr, Hassan Sabry S, Ammar Essam, Ibrahim Mohammad A, Salam Magda Abdel, Farid Mohammad
Department of Obstetrics & Gynecology, Ain Shams University, Abbassia, Cairo, Egypt.
J Low Genit Tract Dis. 2004 Jan;8(1):16-20. doi: 10.1097/00128360-200401000-00005.
To assess the feasibility and performance of direct visual inspection (DVI) of the cervix as a primary tool for the detection of premalignant lesions of the cervix (HPV/CIN 1 and CIN 2,3).
The early cancer detection unit at the Ain Shams University Maternity Hospital in Cairo, Egypt.
The study included 2049 women. Cervical smears were obtained from all women for cytologic evaluation followed by direct visual inspection (DVI) of the cervix after painting with 5% acetic acid. Women whose smear reports showed abnormal cells suggestive of squamous intraepithelial lesion (SIL) or human papillomavirus (HPV) infection or those who showed abnormalities or acetowhite areas on direct visual inspection subsequently were referred for colposcopy and biopsy when appropriate. Colposcopy also was performed for women with negative DVI and negative smears if they had contact bleeding or chronic per vaginal discharge.
Mean (SD) age of women included in the study was 39.9 (10.2) years with their mean (SD) parity 2.9 (1.1). Results of DVI were normal in 1916 women (93.4%) and showed abnormal acetowhite appearance in 133 (6.6%) women. There were 458 (22.4%) colposcopic examinations and 130 biopsies (6.34%) were carried out, picking up 83 cases of premalignant lesions (4.0%). Premalignant lesions were 80 HPV/CIN 1 and CIN 2,3. Direct visual inspection detected 71 of the 83 premalignant lesions (sensitivity, 85.5%; specificity, 96.8%; positive predictive value, 52.6%). Direct visual inspection missed one of the three samples showing CIN 2,3. Cervical cytologic analysis showed abnormal cells in 60 (2.9%) and identified only 14 of the premalignant lesions (sensitivity, 16.9%; specificity, 97.8%; positive predictive value, 23.3%). Twelve of the premalignant lesions had positive smear results and a negative DVI, with none of them being of a high grade.
Direct visual inspection is feasible and had superior sensitivity compare with cervical cytologic analysis in detecting premalignant lesions of the cervix. Direct visual inspection can be used as a primary screening tool with a satisfactory low biopsy rate in low-resource settings or where cytologic services are suboptimal.
评估宫颈直接视诊（DVI）作为检测宫颈前病变（HPV/CIN 1和CIN 2、3）主要工具的可行性和性能。
埃及开罗艾因夏姆斯大学妇产医院的早期癌症检测科室。
该研究纳入了2049名女性。对所有女性进行宫颈涂片以进行细胞学评估，随后在宫颈涂抹5%醋酸后进行直接视诊（DVI）。涂片报告显示有提示鳞状上皮内病变（SIL）或人乳头瘤病毒（HPV）感染的异常细胞的女性，或在直接视诊时显示有异常或醋酸白色区域的女性，随后在适当时被转诊进行阴道镜检查和活检。对于DVI和涂片均为阴性但有接触性出血或慢性阴道分泌物的女性也进行阴道镜检查。
纳入研究的女性平均（标准差）年龄为39.9（10.2）岁，平均（标准差）产次为2.9（1.1）。1916名女性（93.4%）的DVI结果正常，133名女性（6.6%）显示有异常醋酸白色外观。共进行了458次（22.4%）阴道镜检查，130次活检（6.34%），检出83例（4.0%）前病变。前病变为80例HPV/CIN 1和CIN 2、3。直接视诊在83例前病变中检测出71例（敏感性为85.5%；特异性为96.8%；阳性预测值为52.6%）。直接视诊漏检了3例显示CIN Ⅱ、Ⅲ的样本中的1例。宫颈细胞学分析显示60例（2.9%）有异常细胞，仅识别出14例前病变（敏感性为16.9%；特异性为97.8%；阳性预测值为23.3%）。12例前病变涂片结果为阳性而DVI为阴性，且均非高级别病变。
在检测宫颈前病变方面，直接视诊是可行的，且与宫颈细胞学分析相比具有更高的敏感性。在资源匮乏地区或细胞学服务欠佳的情况下，直接视诊可作为一种活检率低且效果良好的初步筛查工具。
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