Mishra Gauravi A, Pimple Sharmila A, Gupta Subhadra D
Department of Preventive Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
South Asian J Cancer. 2019 Apr-Jun;8(2):102-107. doi: 10.4103/sajc.sajc_50_18.
Visual-based screening techniques are low cost and have good sensitivity. Hence, they appear promising for primary screening in low-resource settings. However, to reduce referrals for diagnostic colposcopy, there is need to triage these screen-positive women with test with good specificity.
The study aims to evaluate the performance of cytology as triage for visual inspection after application of 4% acetic acid (VIA) screen-positive women.
Community-based cervical cancer screening using VIA was implemented among socioeconomically disadvantaged women in Mumbai, India.
Cytology was performed on screen-positive women. All primarily screen-positive women underwent colposcopy. Directed biopsies were obtained among women with positive findings on colposcopy. The gold standard used for final disease status was histopathology or negative colposcopy.
Test characteristics of cytology as triage test.
Among the 138,383 population, 16,424 eligible women were screened with VIA. 785 (4.78%) women were VIA positive and 580 women participated in triage with cytology. The sensitivity and specificity of cytology at threshold of atypical squamous cells of undetermined significance in detecting ≥cervical intraepithelial neoplasia (CIN) 2 were 75.0 and 94.7, respectively. The positive and negative predictive values of cytology as triage test were 23.1 and 99.4, respectively, and the false positivity and false negativity rates were 5.34 and 25.0, respectively.
Cytology triage with VIA can reduce referrals for colposcopy to 4.97% of original referrals but may miss around 25%, of high-grade CIN. The substantial reduction in referrals has special implication for low-resource settings, wherein compliance to referral and availability of diagnostic facilities are poor.
基于视觉的筛查技术成本低且灵敏度高。因此，它们在资源匮乏地区的初筛中显得很有前景。然而，为了减少诊断性阴道镜检查的转诊，需要用具有良好特异性的检测方法对这些筛查呈阳性的女性进行分流。
本研究旨在评估细胞学作为4%醋酸（VIA）筛查呈阳性女性视觉检查分流方法的性能。
在印度孟买社会经济地位不利的女性中实施基于社区的VIA宫颈癌筛查。
对筛查呈阳性的女性进行细胞学检查。所有初筛呈阳性的女性均接受阴道镜检查。对阴道镜检查有阳性发现的女性进行定向活检。用于最终疾病状态的金标准是组织病理学或阴性阴道镜检查。
细胞学作为分流检测的检测特征。
在138383名人群中，16424名符合条件的女性接受了VIA筛查。785名（4.78%）女性VIA呈阳性，580名女性参与了细胞学分流。在检测≥宫颈上皮内瘤变（CIN）2时，意义不明确的非典型鳞状细胞阈值下细胞学的灵敏度和特异性分别为75.0和94.7。细胞学作为分流检测的阳性和阴性预测值分别为23.1和99.4，假阳性率和假阴性率分别为5.34和25.0。
VIA细胞学分流可将阴道镜检查的转诊率降至原转诊率的4.97%，但可能会漏诊约25%的高级别CIN。转诊的大幅减少对资源匮乏地区具有特殊意义，因为这些地区对转诊的依从性和诊断设施的可及性较差。
