Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Med Res. 2012 May;135(5):614-20.
BACKGROUND & OBJECTIVES: Developing a feasible and sustainable model of cervical cancer screening in developing countries continues to be a challenge because of lack of facilities and awareness in the population and poor compliance with screening and treatment. This study was aimed to evaluate a single visit approach (SVA) for the management of cervical intraepithelial neoplasia (CIN) using visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) along with loop electrosurgical excision procedure (LEEP) in women attending Gynaecology OPD in a tertiary care hospital in north India.
In this hospital-based study, 450 women receiving opportunistic screening by conventional Pap cytology were also screened by VIA and VILI. VIA/VILI positive cases underwent same-day colposcopy and biopsy of all lesions. If the modified Reid score was >3, the patient underwent LEEP at the same visit.
Of the 450 women screened, 86 (19.1%) and 92 (20.5%) women were VIA and VILI positive, respectively. Detection rates of VIA, VILI and cytology findings at ASCUS threshold were 33.3, 35.5 and 24.4 per 1000, women, respectively to detect a lesion >CIN1. For detection of CIN2+ lesion, detection rates of VIA, VILI and cytology were 20, 22.2 and 22.2 per 1000 women, respectively. Sixteen patients with Reid score >3 underwent the "See-and-treat" protocol. The overtreatment rate was 12.5 per cent and the efficacy of LEEP was 81.3 per cent. There were no major complications.
INTERPRETATION & CONCLUSIONS: The sensitivity of VIA/VILI was comparable to cytology. A single visit approach using visual screening methods at community level by trained paramedical personnel followed by a combination of ablative and excisional therapy can help to decrease the incidence of cervical neoplasia.
由于发展中国家缺乏设施和民众意识，以及对筛查和治疗的依从性差，因此开发一种可行且可持续的宫颈癌筛查模式仍然是一个挑战。本研究旨在评估一种单一就诊方法（SVA），即通过醋酸（VIA）和卢戈氏碘（VILI）联合使用环形电切术（LEEP），对印度北部一家三级保健医院妇科门诊就诊的女性进行宫颈上皮内瘤变（CIN）的管理。
在这项基于医院的研究中，450 名接受常规巴氏细胞学筛查的女性还接受了 VIA 和 VILI 筛查。VIA/VILI 阳性的病例在当天进行阴道镜检查和所有病变的活检。如果改良 Reid 评分>3，则患者在同一就诊时进行 LEEP。
在筛查的 450 名女性中，VIA 阳性者 86 例（19.1%），VILI 阳性者 92 例（20.5%）。VIA、VILI 和 ASCUS 阈值下细胞学发现的检出率分别为每 1000 名女性 33.3、35.5 和 24.4 例，以检测出> CIN1 的病变。对于 CIN2+病变的检出率，VIA、VILI 和细胞学的检出率分别为每 1000 名女性 20、22.2 和 22.2 例。Reid 评分>3 的 16 例患者接受了“见治”方案。过度治疗率为 12.5%，LEEP 的疗效为 81.3%。无重大并发症。
VIA/VILI 的敏感性与细胞学相似。在社区层面由经过培训的辅助医务人员使用视觉筛查方法进行单一就诊方法，然后结合消融和切除术治疗，有助于降低宫颈癌的发病率。
