Sodhani P, Gupta S, Sharma J K, Parashari A, Halder K, Singh V, Sehgal A
Division of Cytopathology, Institute of Cytology and Preventive Oncology (ICMR), NOIDA, Uttar Pradesh, India.
Cytopathology. 2006 Dec;17(6):348-52. doi: 10.1111/j.1365-2303.2006.00351.x.
To determine test characteristics - sensitivity, specificity, positive and negative predictive values - of different screening modalities to detect cervical precancerous and cancerous lesions in order to devise an effective alternative strategy for cervical cancer screening in resource-poor settings.
A total of 472 women presenting with nonspecific gynecologic symptoms were screened by cytology, visual inspection with acetic acid application (VIA), VIA with magnification (VIAM) and human papillomavirus (HPV)-DNA testing. Colposcopic examination was performed in all and on-site biopsy was taken if any grade I and above lesion was detected on colposcopy (230). On histopathological examination, 105 showed cervical intraepithelial neoplasia II and above lesions. Sensitivity, specificity and predictive values for each test were calculated taking colposcopy and or directed biopsy as the gold standard. Comparisons were made with cytology in order to assess the feasibility of alternative strategies in resource-poor settings.
VIA was less sensitive (86.7% versus 91.4%) but more specific (90.7% versus 86.6%) than cytology at low grade squamous intraepithelial lesion (LSIL) threshold but the difference was not statistically significant (P > 0.01). HPV testing improved the sensitivity over cytology (97.1% versus 91.4%) but there was a nonsignificant loss of specificity (84.2% versus 86.6%). Results of VIAM were more or less similar to VIA.
VIA can be used as a mass screening tool for cervical cancer in resource-poor settings.
确定不同筛查方式检测宫颈癌前病变和癌性病变的检测特征——敏感性、特异性、阳性和阴性预测值，以便为资源匮乏地区设计一种有效的宫颈癌筛查替代策略。
对472名出现非特异性妇科症状的女性进行了细胞学检查、醋酸涂抹肉眼观察（VIA）、放大醋酸涂抹肉眼观察（VIAM）和人乳头瘤病毒（HPV）-DNA检测。对所有人进行了阴道镜检查，如果在阴道镜检查中发现任何I级及以上病变，则进行现场活检（230例）。经组织病理学检查，105例显示宫颈上皮内瘤变II级及以上病变。以阴道镜检查和/或定向活检为金标准，计算每项检测的敏感性、特异性和预测值。与细胞学检查进行比较，以评估资源匮乏地区替代策略的可行性。
在低级别鳞状上皮内病变（LSIL）阈值下，VIA的敏感性低于细胞学检查（86.7%对91.4%），但特异性高于细胞学检查（90.7%对86.6%），但差异无统计学意义（P>0.01）。HPV检测比细胞学检查提高了敏感性（97.1%对91.4%），但特异性略有下降（84.2%对86.6%），差异无统计学意义。VIAM的结果与VIA大致相似。
VIA可作为资源匮乏地区宫颈癌的大规模筛查工具。
