醋酸或卢戈碘目视检查联合用于检测宫颈癌前病变的准确性：一项荟萃分析。

Accuracy of combinations of visual inspection using acetic acid or lugol iodine to detect cervical precancer: a meta-analysis.

机构信息

Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.

Geneva Foundation for Medical Education and Research, Geneva, Switzerland.

出版信息

BJOG. 2018 Apr;125(5):545-553. doi: 10.1111/1471-0528.14783. Epub 2017 Jul 26.

DOI:10.1111/1471-0528.14783

PMID:28603909

Abstract

BACKGROUND

Visual inspection of the cervix with acetic acid (VIA) or with Lugol's iodine (VILI) have been evaluated for cervical cancer screening in developing countries.

OBJECTIVES

To assess the diagnostic accuracy and clinical utility of visual methods to detect cervical intraepithelial neoplasia grade 2+ (CIN2+) using: (1) VIA alone; (2) VILI alone; (3) co-testing; and (4) VILI as a triage test of a positive VIA result.

SEARCH STRATEGY

PubMed, EMBASE, and the Cochrane Library were searched up to May 2016.

SELECTION CRITERIA

All reports on the accuracy of VIA and VILI, or combinations of VIA/VILI, to detect CIN2+ were identified. Histology and colposcopy when no biopsy was taken were used as the reference standard.

DATA COLLECTION AND ANALYSIS

Selected studies were scored on methodological quality, and sensitivity and specificity were computed. Clinical utility was assessed from the positive predictive value (PPV) and the complement of the negative predictive value (cNPV).

MAIN RESULTS

We included 23 studies comprising 101 273 women. The pooled sensitivity and specificity of VILI was 88 and 86%, respectively. VILI was more sensitive, but not less specific, compared with VIA (relative sensitivity = 1.11; 95% confidence interval, 95% CI, 1.06-1.16; relative specificity = 0.98; 95% CI 0.95-1.01). Co-testing was hardly more sensitive, but significantly less specific, than VILI alone. VILI to triage VIA-POSITIVE women was not less sensitive, but more specific, compared with VIA alone (relative sensitivity = 0.98, 95% CI 0.96-1.01; relative specificity = 1.04, 95% CI 1.02-1.05). The average PPVs were low (range 11-16%), whereas the cNPV varied between 0.3% (VILI, co-testing) and 0.6% (triage).

CONCLUSIONS

Although imperfect, VILI alone appeared to be the most useful visual screening strategy.

TWEETABLE ABSTRACT

VILI alone seems to be the most useful visual screening test for cervical cancer screening.

摘要

背景

在发展中国家，醋酸（VIA）或卢戈氏碘液（VILI）肉眼观察子宫颈已被评估用于宫颈癌筛查。

目的

评估单独使用 VIA、单独使用 VILI、联合检测（co-testing）和 VILI 作为阳性 VIA 结果的分流试验，用于检测宫颈上皮内瘤变 2 级及以上（CIN2+）的诊断准确性和临床实用性。

检索策略

检索了截至 2016 年 5 月的 PubMed、EMBASE 和 Cochrane 图书馆。

选择标准

确定了所有关于 VIA 和 VILI 或 VIA/VILI 联合检测用于检测 CIN2+的准确性的报告。当未行活检时，以组织学和阴道镜检查作为参考标准。

数据收集和分析

对所选研究进行了方法学质量评分，并计算了敏感性和特异性。从阳性预测值（PPV）和阴性预测值补（cNPV）评估临床实用性。

主要结果

共纳入了 23 项研究，涉及 101273 名女性。VILI 的汇总敏感性和特异性分别为 88%和 86%。与 VIA 相比，VILI 的敏感性更高，但特异性无差异（相对敏感性=1.11；95%置信区间，95%CI，1.06-1.16；相对特异性=0.98；95%CI 0.95-1.01）。联合检测的敏感性稍高，但特异性显著降低。VILI 对 VIA 阳性女性进行分流并不比单独使用 VIA 更敏感，但特异性更高（相对敏感性=0.98，95%CI 0.96-1.01；相对特异性=1.04，95%CI 1.02-1.05）。平均 PPV 较低（范围 11%-16%），而 cNPV 介于 0.3%（VILI、联合检测）和 0.6%（分流）之间。