Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
Int J Gynecol Cancer. 2010 Jul;20(5):862-8. doi: 10.1111/IGC.0b013e3181e02f77.
To compare the sensitivity, specificity, positive and negative predictive values, and accuracy of Papanicolaou test with visual inspection with acetic acid (VIA)/VIA using magnification devices (VIAM) and develop the best strategy for screening in low resource settings.
This is a prospective cross-sectional study on 408 symptomatic multiparous women in the reproductive age group, sequentially using the Papanicolaou test, the VIA, and the VIAM for screening. Women with a positive screening test underwent guided biopsy and endocervical curettage. The site of biopsy was recorded. Histopathological findings were taken as the "gold" standard in comparing the methods.
The mean (SD) age was 32.3 (6.8) years (range, 15-49 years), whereas the mean (SD) parity was 2.9 (1.2) (range, 1-9). Abnormal cytological findings were detected in 2.9% patients, whereas the remaining smears were negative for any intraepithelial lesion or malignancy. A total of 113 cases were screened positive by one/all methods. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Papanicolaou test, the VIA, and the VIAM were 24, 98, 42, 96, and 94%; 95, 78, 19, 99, and 79%; and 95, 78, 19, 99, and 79%, respectively, for high-grade lesions.
The Papanicolaou test had low sensitivity but high specificity, whereas visual detection methods had a high sensitivity in addition to being cheaper. Alternative methods of screening such as VIA/VIAM can be a valuable alternative to the Papanicolaou test for cervical cancer screening in low resource settings. Visual inspection using magnification devices may be of benefit over VIA in doubtful cases.
比较巴氏涂片试验与醋酸视觉检查（VIA）/VIA 联合放大设备（VIAM）的敏感度、特异度、阳性预测值、阴性预测值和准确率，并制定在资源有限环境下的最佳筛查策略。
这是一项针对 408 例适龄多产妇的前瞻性横断面研究，她们依次接受巴氏涂片试验、VIA 和 VIAM 筛查。筛查阳性的妇女接受引导性活检和宫颈搔刮术。记录活检部位。将组织病理学发现作为比较方法的“金标准”。
平均（标准差）年龄为 32.3（6.8）岁（范围，15-49 岁），平均（标准差）产次为 2.9（1.2）（范围，1-9）。细胞学异常发现见于 2.9%的患者，其余涂片均未发现上皮内病变或恶性肿瘤。共有 113 例患者经一种/所有方法筛查阳性。巴氏涂片试验、VIA 和 VIAM 的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为 24%、98%、42%、96%和 94%；95%、78%、19%、99%和 79%；95%、78%、19%、99%和 79%，用于高级别病变。
巴氏涂片试验敏感度低但特异度高，而视觉检测方法敏感度高，且价格低廉。VIA/VIAM 等替代筛查方法可能是资源有限环境下宫颈癌筛查巴氏涂片试验的替代方法。在可疑病例中，放大设备的视觉检查可能优于 VIA。
