Basic Health International, Mount Sinai School of Medicine, NY 10029, USA.
Int J Gynaecol Obstet. 2011 Apr;113(1):68-71. doi: 10.1016/j.ijgo.2010.10.018. Epub 2011 Jan 26.
The present study assessed the adequacy and predictive performance of visual inspection with acetic acid (VIA) in women over the age of 50 years and compared the specificity and sensitivity of VIA with that of the conventional cytology.
In total, 588 Salvadoran women ages 50-79 underwent VIA, Pap smear, and cervical biopsy. VIA was considered adequate if the squamocolumnar junction was completely visible. A positive biopsy was defined as cervical intraepithelial neoplasia (CIN) 2 or worse.
Age was negatively correlated with VIA adequacy (P=0.04). Nevertheless, the majority of women-even in the older age groups-had adequate examinations. The adequacy of VIA was positively correlated with gravida (P=0.01) and was higher in women who had been treated by cryotherapy (P=0.02). The rate of positive biopsies was unexpectedly low (n=6 [1%]) making it difficult to assess the predictive performance of VIA. In this small sample, the sensitivities of VIA (17%) and Pap (33%) were low; the high number of false negatives could not be fully explained by inadequacy of the examinations.
Adequacy of VIA declined with age. However, the squamocolumnar junction was visible to the naked eye in the majority of women, indicating that they are good candidates for VIA.
本研究评估了醋酸视觉检查（VIA）在 50 岁以上女性中的充分性和预测性能，并比较了 VIA 的特异性和敏感性与传统细胞学的特异性和敏感性。
共有 588 名年龄在 50-79 岁的萨尔瓦多妇女接受了 VIA、巴氏涂片和宫颈活检。如果鳞柱交界完全可见，则认为 VIA 充分。阳性活检定义为宫颈上皮内瘤变（CIN）2 级或更高级别。
年龄与 VIA 充分性呈负相关（P=0.04）。尽管如此，大多数女性-即使在年龄较大的组中-也有充分的检查。VIA 的充分性与孕次呈正相关（P=0.01），并且在接受冷冻治疗的女性中更高（P=0.02）。阳性活检的发生率出乎意料地低（n=6 [1%]），使得难以评估 VIA 的预测性能。在这个小样本中，VIA（17%）和巴氏涂片（33%）的敏感性较低；大量的假阴性不能完全用检查的不充分来解释。
VIA 的充分性随年龄增长而下降。然而，在大多数女性中，鳞柱交界肉眼可见，表明她们是 VIA 的良好候选者。
