Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Int J Gynecol Cancer. 2019 Jan;29(1):23-27. doi: 10.1136/ijgc-2018-000006.
To evaluate the use of a portable, rechargeable colposcope combined with human papillomavirus (HPV) testing, as compared with HPV testing alone, for screening of cervical cancer and pre-cancerous lesions.
This was a cross-sectional study among 488 women in Baoshan County, Yunnan. The women underwent HPV testing followed by Gynocular portable colposcopy with visual inspection with acetic acid. Obvious lesions were biopsied. If portable colposcopy testing was negative but HPV testing was positive, the women underwent follow-up testing with thin-prep cytology and traditional colposcopy. Cervical biopsies were performed for any abnormalities. Histopathology was followed up with diagnosis and treatment.
Among 488 women screened with portable colposcopy, 24 women underwent biopsy based on positive colposcopy screening. Of these 24 women, three were HPV positive and 21 were HPV negative. Five women had cervical intra-epithelial neoplasia (CIN) I and one had advanced cervical cancer. Forty-six women tested positive for HPV. Three of these women had screened positive on preliminary colposcopy, with one positive for CIN III/squamous cell carcinoma and one woman with CIN I. Forty-three women underwent follow-up testing with thin-prep cytology. Two women had atypical squamous cells of undetermined significance and five had low-grade squamous intra-epithelial lesions and were biopsied; three women had CIN I, one had CIN II and one had CIN III. HPV testing and portable colposcopy was more sensitive but slightly less specific than portable colposcopy or HPV testing alone.
While HPV testing has high sensitivity and specificity for the detection of pre-cancerous and cancerous lesions and portable colposcopy has lower specificity, both methods of detection have low positive predictive value and high negative predictive value. In tandem, HPV testing and portable colposcopy had higher sensitivity for detection among women who underwent biopsies. In clinical practice, portable colposcopy was an effective, easy and affordable tool to transport to villages where cytology is not currently feasible.
评估便携式、可充电阴道镜联合人乳头瘤病毒（HPV）检测用于宫颈癌及癌前病变筛查的效果，与单独 HPV 检测相比。
这是一项横断面研究，研究对象为云南省保山市的 488 名女性。所有女性均先接受 HPV 检测，然后行 Gynocular 便携式阴道镜检查，行醋酸视觉检查。明显病变行活检。如果阴道镜检查阴性但 HPV 检测阳性，这些女性行薄层液基细胞学检查和传统阴道镜检查随访。任何异常均行宫颈活检。组织病理学检查随访诊断和治疗。
在接受便携式阴道镜筛查的 488 名女性中，有 24 名根据阳性阴道镜筛查结果行活检。这 24 名女性中，有 3 名 HPV 阳性，21 名 HPV 阴性。5 名女性患有宫颈上皮内瘤变（CIN）Ⅰ级，1 名患有晚期宫颈癌。46 名女性 HPV 检测阳性。其中 3 名女性初步阴道镜检查阳性，1 名 CIN Ⅲ/鳞状细胞癌阳性，1 名 CIN Ⅰ阳性。43 名女性行薄层液基细胞学检查随访。其中 2 名女性非典型鳞状细胞不能明确意义，5 名女性低级别鳞状上皮内病变行活检；3 名女性 CIN Ⅰ级，1 名女性 CIN Ⅱ级，1 名女性 CIN Ⅲ级。HPV 检测和便携式阴道镜检查的敏感性比单独使用阴道镜或 HPV 检测均高，但特异性略低。
HPV 检测对癌前病变和癌症的检测具有高敏感性和特异性，而便携式阴道镜检查的特异性较低，但两种检测方法的阳性预测值均较低，阴性预测值均较高。联合应用 HPV 检测和便携式阴道镜检查时，活检女性的敏感性更高。在临床实践中，便携式阴道镜检查是一种有效、简便且经济的工具，可用于无法开展细胞学检查的农村地区。
