Nessa Ashrafun, Nahar Khadiza Nurun, Begum Shirin Akhter, Anwary Shahin Ara, Hossain Fawzia, Nahar Khairun
Gyne-oncology Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh E-mail :
Asian Pac J Cancer Prev. 2013;14(12):7607-11. doi: 10.7314/apjcp.2013.14.12.7607.
Cervical cancer continues to be a major problem in Bangladesh with approximately 18,000 new cases annually of which over 10,000 women die from it. Visual inspection of the cervix after 3-5% acetic acid (VIA) application is a simple and easy to learn method for cervical cancer screening, although cytology-based screening is more often applied in developed countries where it has successfully reduced the prevalence of cervical cancer.
To compare the efficacy of VIA and cytology-based primary methods for cervical cancer screening in Bangladesh.
This hospital based comparative study was conducted at the VIA centre and Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2008 to October 2010.
Among 650 women, 74 (11.4%) were VIA+ve and 8 (1.2%) had abnormalities in their Pap smear reports. During colposcopy, 38 (7.7%) women had different grades of CIN and 4 (0.6%) had cervical cancer. The gold standard histology findings proved 20 women had CIN I, 14 had CIN II/II and 4 had cervical cancer. Among the 38 histology diagnosed abnormalities, VIA test could identify 30 abnormalities including two cervical cancers. However, Pap smear could detect only 8 cases of histological abnormalities (2 low grade and 6 had high grade lesion) and it missed all the cervical cancer cases. The sensitivity and specificity of VIA were 88.9% and 52.1%. The positive predictive value (PPV) and negative predictive value (NPV) were 41.0%, and 92.6% respectively. Moreover, the sensitivity, specificity, PPV and NPV of Pap smear were 33.3%, 95.8%, 75.0% and 79.3%, respectively.
VIA test should be used as the primary screening tool even with its low sensitivity and specificity in low resource countries like Bangladesh. False positive results may be greater, but overtreatment can be minimized by colposcopy evaluation of the VIA positive women.
宫颈癌在孟加拉国仍然是一个主要问题,每年约有18000例新发病例,其中超过10000名女性死于该病。应用3%-5%醋酸后进行宫颈视诊(VIA)是一种简单易学的宫颈癌筛查方法,尽管在发达国家更常采用基于细胞学的筛查方法,且该方法已成功降低了宫颈癌的患病率。
比较VIA和基于细胞学的主要宫颈癌筛查方法在孟加拉国的效果。
这项基于医院的比较研究于2008年10月至2010年10月在孟加拉国谢赫穆吉布医科大学(BSMMU)的VIA中心和阴道镜诊所进行。
在650名女性中,74名(11.4%)VIA检查呈阳性,8名(1.2%)巴氏涂片报告有异常。在阴道镜检查中,38名(7.7%)女性有不同级别的宫颈上皮内瘤变(CIN),4名(0.6%)患有宫颈癌。金标准组织学检查结果证明,20名女性患有CIN I,14名患有CIN II/III,4名患有宫颈癌。在38例经组织学诊断的异常病例中,VIA检查能识别30例异常,包括2例宫颈癌。然而,巴氏涂片仅能检测到8例组织学异常(2例低级别和6例高级别病变),且漏诊了所有宫颈癌病例。VIA的敏感性和特异性分别为88.9%和52.1%。阳性预测值(PPV)和阴性预测值(NPV)分别为41.0%和92.6%。此外,巴氏涂片的敏感性、特异性、PPV和NPV分别为33.3%、95.8%、75.0%和79.3%。
在像孟加拉国这样资源匮乏的国家,即使VIA检查的敏感性和特异性较低,也应将其用作主要筛查工具。假阳性结果可能更多,但通过对VIA阳性女性进行阴道镜评估可将过度治疗降至最低。