Puntachai Pongsun, Darojn Darigar, Chumworathayi Bandit, Chaousriku Wichian
Department of Obstetrics and Gynecology, Sappasitthiprasong Hospital, Ubon Ratchathani, Thailand.
Asian Pac J Cancer Prev. 2011;12(10):2665-8.
To compare the sensitivity, specificity, positive and negative predictive values of visual inspection with acetic acid directed cervical biopsy (VDB) in combination with random cervical biopsy (VRB) and endocervical curettage (ECC) to colposcopic directed biopsy (CDB) plus ECC in detecting cervical lesions (HSIL or more) in Thailand.
A diagnostic-test study was carried out on 164 women with abnormal Pap smear at a tertiary care teaching hospital from March 2011 to June 2011. The women with abnormal Pap smears had further investigations such as; VDB and/or VRB, and CDB plus ECC, and/or loop electrosurgical excision procedure (LEEP). Either VDB plus VRB plus ECC or CDB plus ECC, sometimes LEEP, were used to diagnose cervical lesions. Severest histopathology from any means was taken as the gold standard.
There were 164 patients included in analyses. The sensitivity of VDB plus VRB plus ECC to detect cervical lesions was 95.9% (95%CI, 91.4%-98.1%) compared to the sensitivity of CDB plus ECC of 97.3% (95%CI, 93.2%-98.9%). The two were very similar (mean difference -1.4%, 95%CI, -5.4%-2.6%, by Z-test).
Thus VDB plus VRB plus ECC can substitute for CDB plus ECC in detecting cervical lesions in low-resource settings.
比较在泰国，醋酸目视引导下宫颈活检（VDB）联合随机宫颈活检（VRB）及宫颈管刮术（ECC）与阴道镜引导下活检（CDB）联合ECC在检测宫颈病变（高级别鳞状上皮内病变或更严重病变）方面的敏感性、特异性、阳性预测值和阴性预测值。
2011年3月至2011年6月，在一家三级护理教学医院对164名巴氏涂片异常的女性进行了诊断性试验研究。巴氏涂片异常的女性接受了进一步检查，如VDB和/或VRB、CDB联合ECC，和/或环形电切术（LEEP）。采用VDB联合VRB联合ECC或CDB联合ECC，有时采用LEEP来诊断宫颈病变。将任何方法得出的最严重组织病理学结果作为金标准。
164例患者纳入分析。VDB联合VRB联合ECC检测宫颈病变的敏感性为95.9%（95%CI，91.4%-98.1%），而CDB联合ECC的敏感性为97.3%（95%CI，93.2%-98.9%）。两者非常相似（通过Z检验，平均差异为-1.4%，95%CI，-5.4%-2.6%）。
因此，在资源匮乏地区，VDB联合VRB联合ECC可替代CDB联合ECC用于检测宫颈病变。
