Li N, Shi J-F, Franceschi S, Zhang W-H, Dai M, Liu B, Zhang Y-Z, Li L-K, Wu R-F, De Vuyst H, Plummer M, Qiao Y-L, Clifford G
International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France.
Br J Cancer. 2009 Feb 10;100(3):532-7. doi: 10.1038/sj.bjc.6604840. Epub 2009 Jan 6.
To evaluate alternative cervical cancer screening methods, digital colposcopy and collection of cervical exfoliated cells for liquid-based cytology (LBC) and hybrid capture 2 (HC2) testing were performed among 2562 women aged 15-59 years in three study sites in the People's Republic of China (rural Shanxi province, Shenyang city in Liaoning province and Shenzhen city in Guangdong province). Visual inspection with acetic acid (VIA) was also evaluated independently from colposcopy. A total of 74 cases of histologically confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) were identified, and 16 CIN2+ cases were imputed among unbiopsied women to correct for verification bias. Corrected sensitivity for CIN2+ was 37% for VIA, 54% for colposcopy, 87% for LBC with a threshold of atypical cells of undetermined significance (LBC>or=ASCUS), 90% for HC2, 84% for LBC using HC2 to triage ASCUS and 96% for positivity to LBC>or=ASCUS or HC2. For VIA, sensitivity was much lower among women >or=40 years (12%) than those aged <or=39 years (50%). Specificity varied from 77% for positivity to LBC>or=ASCUS or HC2, up to 94% for LBC using HC2 to triage ASCUS. In conclusion, LBC, HC2 and their combinations performed well, whereas VIA missed a majority of CIN2+, particularly in older women. Digital colposcopy performed better than VIA, but still missed nearly half of CIN2+ in this study.
为评估宫颈癌筛查的替代方法，在中国（山西省农村、辽宁省沈阳市和广东省深圳市）的三个研究地点，对2562名年龄在15 - 59岁的女性进行了数码阴道镜检查，并采集宫颈脱落细胞用于液基细胞学检查（LBC）和杂交捕获2代（HC2）检测。醋酸肉眼观察法（VIA）也独立于阴道镜检查进行了评估。共确诊74例组织学证实的2级或更高级别宫颈上皮内瘤变（CIN2+），并在未活检的女性中推算出16例CIN2+病例以校正验证偏倚。VIA对CIN2+的校正敏感性为37%，阴道镜检查为54%，LBC以意义不明确的非典型细胞为阈值（LBC≥非典型鳞状细胞不能明确意义[ASCUS]）时为87%，HC2为90%，LBC使用HC2对ASCUS进行分流时为84%，LBC≥ASCUS或HC2阳性时为96%。对于VIA，40岁及以上女性（12%）的敏感性远低于39岁及以下女性（50%）。特异性从LBC≥ASCUS或HC2阳性时的77%到LBC使用HC2对ASCUS进行分流时的94%不等。总之，LBC、HC2及其联合检测表现良好，而VIA漏诊了大多数CIN2+病例，尤其是老年女性。数码阴道镜检查比VIA表现更好，但在本研究中仍漏诊了近一半的CIN2+病例。
