Bhatla Neerja, Puri Kriti, Kriplani Alka, Iyer Venkateswaran K, Mathur Sandeep R, Mani Kalaivani, Pandey Ravindra M
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
Aust N Z J Obstet Gynaecol. 2012 Apr;52(2):133-9. doi: 10.1111/j.1479-828X.2011.01402.x. Epub 2012 Jan 25.
Cervical cancer screening using cytology is expensive and requires repeat testing with loss to follow-up for triage. Adjunctive testing using two tests in a parallel or sequential combination can improve diagnostic accuracy, decrease costs and minimise referral rates.
To evaluate the performance of visual inspection with acetic acid (VIA), human papillomavirus (HPV) DNA and cervical cytology in sequential and parallel combinations, to determine the optimum screening strategy.
A total of 548 symptomatic women presenting to a gynaecology clinic were screened using conventional cytology; HPV testing of self- and physician-collected samples using HC2 assay; and VIA. All women underwent colposcopy with biopsy from all lesions as the reference standard. Test characteristics were calculated individually, and then applied jointly in parallel and sequential combinations.
Biopsy-proven CIN2+ was present in 40 (7.8%) women. The sensitivity and specificity, respectively, of the various tests were as follows - VIA 82.5, 66.9%, Pap (≥ASCUS) 77.5, 86.8%, HPV-Physician (HPV(P)) 90.0, 91.5%, HPV-Self (HPV(S)) 80.0, 88.1%. Among the adjunctive testing scenarios, sequential testing performed better than parallel. VIA followed by HPV test had the highest specificity (90.4%) and diagnostic accuracy (90.5%), comparable to HPV-P followed by Pap.
Sequential testing combination of VIA and HPV, followed by colposcopy and directed biopsy for diagnosis, combines economic viability with high scientific fidelity. The high specificity and negative predictive value reduce referral and treatment rates, as well as number of visits required for diagnosis. HPV (P) followed by reflex Pap is a suitable option for high resource situations with access to liquid-based cytology.
采用细胞学方法进行宫颈癌筛查成本高昂，且需要重复检测，同时存在失访进行分流的情况。采用两种检测方法并行或序贯联合的辅助检测可提高诊断准确性、降低成本并使转诊率降至最低。
评估醋酸肉眼观察法（VIA）、人乳头瘤病毒（HPV）DNA检测和宫颈细胞学检查在序贯及并行联合检测中的性能，以确定最佳筛查策略。
对548名到妇科门诊就诊的有症状女性进行常规细胞学筛查；使用HC2检测法对自行采集和医生采集的样本进行HPV检测；以及VIA检测。所有女性均接受阴道镜检查，并对所有病变进行活检，将其作为参考标准。分别计算各项检测的特征，然后将其应用于并行和序贯联合检测中。
40名（7.8%）女性经活检证实存在CIN2+病变。各项检测的敏感性和特异性分别如下——VIA为82.5%、66.9%，巴氏涂片（≥非典型鳞状细胞）为77.5%、86.8%，医生采集样本的HPV检测（HPV(P)）为90.0%、91.5%，自行采集样本的HPV检测（HPV(S)）为80.0%、88.1%。在辅助检测方案中，序贯检测的表现优于并行检测。VIA检测后进行HPV检测具有最高的特异性（90.4%）和诊断准确性（90.5%），与HPV-P检测后进行巴氏涂片检测相当。
VIA和HPV的序贯联合检测，随后进行阴道镜检查和定向活检以进行诊断，将经济可行性与高科学准确性相结合。高特异性和阴性预测值降低了转诊和治疗率，以及诊断所需的就诊次数。HPV(P)检测后进行反射性巴氏涂片检测是在可获得液基细胞学检查的高资源情况下的合适选择。
