Perkins R B, Langrish S M, Stern L J, Figueroa J, Simon C J
Department of Obstetrics and Gynecology, Boston University Medical Center, Boston, MA 02118, USA.
Trop Med Int Health. 2007 Sep;12(9):1018-25. doi: 10.1111/j.1365-3156.2007.01888.x.
To compare visual inspection with acetic acid (VIA) to Papanicolau (PAP) smears in a community setting in a developing nation.
Women undergoing cervical cancer screening in Honduras received either VIA and PAP smears (VIA/PAP group) or PAP smears alone (PAP-only group). Local healthcare providers performed PAP screening. A VIA-trained nurse performed VIA exams. All PAP smears were processed in Honduras. PAP smears from the VIA/PAP group were reviewed in the United States. Women with positive VIA or PAP tests were offered colposcopy. We compared the relative accuracy of PAP smears and VIA and the proportions of women completing follow-up colposcopy after positive screening tests.
In total, 1709 PAP smears were performed including women from both the VIA/PAP and PAP-only groups. Nine PAP smears were positive (0.5%). Three women completed colposcopy (33%). All three had biopsy-confirmed dysplasia. In the VIA/PAP group (n = 339), 49 VIA exams were abnormal (14%) and two PAP smears were abnormal when read in Honduras (0.6%). When reviewed in the United States, 14 of the 339 PAP smears were abnormal (4%). Forty women (83%) completed follow-up colposcopy after a positive VIA exam. Twenty-three had biopsy-proven dysplasia. All 23 dysplasia cases had negative PAP smear readings in Honduras; four PAP smears were reclassified as positive in the United States.
Although few developing countries can maintain high-quality PAP smear programmes, many governments and charitable organizations support cervical cancer screening programmes that rely on PAP smears. This study underscores the need to promote alternative technologies for cervical cancer screening in low-resource settings.
在一个发展中国家的社区环境中，比较醋酸肉眼观察法（VIA）与巴氏涂片检查（PAP）。
在洪都拉斯接受宫颈癌筛查的女性，一部分接受VIA和PAP涂片检查（VIA/PAP组），另一部分仅接受PAP涂片检查（仅PAP组）。当地医疗服务提供者进行PAP筛查。一名经过VIA培训的护士进行VIA检查。所有PAP涂片均在洪都拉斯进行处理。VIA/PAP组的PAP涂片在美国进行复查。VIA或PAP检查呈阳性的女性接受阴道镜检查。我们比较了PAP涂片和VIA的相对准确性，以及筛查试验呈阳性后完成后续阴道镜检查的女性比例。
总共进行了1709次PAP涂片检查，包括VIA/PAP组和仅PAP组的女性。9次PAP涂片呈阳性（0.5%）。3名女性完成了阴道镜检查（33%）。所有3名女性经活检确诊为发育异常。在VIA/PAP组（n = 339）中，49次VIA检查异常（14%），在洪都拉斯读取时2次PAP涂片异常（0.6%）。在美国复查时，339次PAP涂片中14次异常（4%）。40名女性（83%）在VIA检查呈阳性后完成了后续阴道镜检查。23名女性经活检证实为发育异常。所有23例发育异常病例在洪都拉斯的PAP涂片读数均为阴性；在美国，4次PAP涂片被重新分类为阳性。
尽管很少有发展中国家能够维持高质量的PAP涂片检查项目，但许多政府和慈善组织支持依赖PAP涂片的宫颈癌筛查项目。本研究强调了在资源匮乏地区推广宫颈癌筛查替代技术的必要性。
