Umulisa M Chantal, Franceschi Silvia, Baussano Iacopo, Tenet Vanessa, Uwimbabazi Mathilde, Rugwizangoga Belson, Heideman Daniëlle A M, Uyterlinde Anne M, Darragh Teresa M, Snijders Peter J F, Sayinzoga Felix, Clifford Gary M
Ministry of Health of Rwanda, Kigali, Rwanda.
Cancer Epidemiology Unit, Aviano National Cancer Institute IRCCS, Aviano, Italy.
BMC Womens Health. 2018 Apr 24;18(1):59. doi: 10.1186/s12905-018-0549-5.
A pilot screening campaign in Rwanda, based on careHPV-testing followed by visual inspection with acetic acid triage (careHPV+VIA triage), was evaluated against other WHO-recommended screening options, namely HPV screen-and-treat and VIA screen-and-treat.
764 women aged 30-69 underwent at visit 1: i) VIA, and cervical cell collection for ii) careHPV in Rwanda, and iii) liquid-based cytology and GP5+/6+ HR-HPV PCR in The Netherlands. All 177 women positive by VIA, careHPV and/or PCR were recalled, of whom 84% attended. At visit 2, VIA was again used to triage screen-positive women for treatment and to obtain biopsies from all women either from visible lesions or at 12 o'clock of the squamocolumnar junction. Cross-sectional screening indices were estimated primarily against histological high-grade squamous intraepithelial lesions or worse (hHSIL+), after imputation of missing histology data, based on 1-visit or 2-visit approaches.
In a 1-visit screen-and-treat approach, VIA had sensitivity and specificity of 41% and 96%, respectively, versus 71% and 88% for careHPV, and 88% and 86% for PCR. In a 2-visit approach (in which hHSIL+ imputed among women without visit 2 were considered untreated) careHPV sensitivity dropped to 59% due to loss of 13% of hHSIL+. For careHPV+VIA triage, sensitivity dropped further to 35%, as another 24% of hHSIL+ were triaged to no treatment.
CareHPV was not as sensitive as gold-standard PCR, but detected considerably more hHSIL+ than VIA. However, due to careHPV-positive hHSIL+ women being lost to follow-up and/or triaged to no treatment, 2-visit careHPV+VIA triage did not perform better than VIA screen-and-treat.
在卢旺达开展了一项试点筛查活动，该活动基于careHPV检测，随后进行醋酸视觉检查分流（careHPV+VIA分流），并与世界卫生组织推荐的其他筛查方案进行了对比评估，即HPV筛查与治疗以及VIA筛查与治疗。
764名年龄在30至69岁的女性在第1次就诊时接受了以下检查：i）在卢旺达进行VIA检查以及采集宫颈细胞用于ii）careHPV检测，在荷兰进行iii）液基细胞学检查和GP5+/6+ HR-HPV PCR检测。所有通过VIA、careHPV和/或PCR检测呈阳性的177名女性均被召回，其中84%前来就诊。在第2次就诊时，再次使用VIA对筛查呈阳性的女性进行分流以确定治疗方案，并从所有女性的可见病变处或鳞柱交界的12点位置获取活检样本。在对缺失的组织学数据进行插补后，主要根据单次就诊或两次就诊的方法，针对组织学高级别鳞状上皮内病变或更严重病变（hHSIL+）估计横断面筛查指标。
在单次就诊筛查与治疗方法中，VIA的敏感性和特异性分别为41%和96%，careHPV分别为71%和88%，PCR分别为88%和86%。在两次就诊方法中（其中将未进行第2次就诊的女性中推断为hHSIL+的情况视为未治疗），由于13%的hHSIL+病例流失，careHPV的敏感性降至59%。对于careHPV+VIA分流，敏感性进一步降至35%，因为另有24%的hHSIL+病例被分流至无需治疗。
CareHPV不如金标准PCR敏感，但检测到的hHSIL+病例比VIA多得多。然而，由于careHPV检测呈阳性的hHSIL+女性失访和/或被分流至无需治疗，两次就诊的careHPV+VIA分流效果并不优于VIA筛查与治疗。
