Goel Bharti, Desouza Argyia, Sehgal Alka, Dubey Sunita
Department of Obstetrics and Gynaecology, Government Medical College and Hospital (GMCH), Sector - 32, Chandigarh, India.
Department of Obstetrics and Gynaecology, K.S Hegde Medical Academy, Mangaluru, India.
J Obstet Gynaecol India. 2022 Dec;72(6):503-508. doi: 10.1007/s13224-022-01674-3. Epub 2022 Aug 24.
The two prongs for cervical cancer prevention are vaccination for primary prevention and effective screening for preinvasive and early invasive disease. Until human papilloma virus DNA testing can be provided in low resource settings, screening with VIA is the most feasible option. Various innovative methods have been used to improve the diagnostic accuracy of visual inspection with acetic acid (VIA). This study explores one such option.
We modified VIA (VIA-Md) by using a magnifying lens mounted with battery operated light emitting devices (LEDs) to study the acetowhite areas on the cervix. The peak wavelength of the light from the LEDs was in the bluish white range. The results of VIA and VIA-Md were compared using colposcopy directed biopsy as the reference standard.
The study was conducted in 273 eligible women. The sensitivity of VIA and VIA-Md for detecting CIN2 + lesions were 57.1% and 100% respectively. The specificity of VIA and VIA-Md were 99.2% and 89.5%; and values using the colposcopy directed biopsy as the reference standard were 0.000 and 0.018 respectively. However, VIA-Md was also effective in identifying 21 out of the total 32 cases of chronic cervicitis identified by colposcopy directed biopsy.
VIA-Md appears to be a highly sensitive test for detection of CIN2 + lesions. However, because of concerns regarding lower specificity, VIA-Md can be used simultaneously with VIA as an effective tool for triaging women who need to be kept under close surveillance or who might benefit from local ablative therapy.
宫颈癌预防的两个主要方面是一级预防的疫苗接种以及对癌前病变和早期浸润性疾病的有效筛查。在资源匮乏地区能够提供人乳头瘤病毒DNA检测之前，醋酸染色肉眼观察法（VIA）筛查是最可行的选择。已经采用了各种创新方法来提高醋酸肉眼观察法（VIA）的诊断准确性。本研究探讨了其中一种方法。
我们通过使用安装有电池供电发光装置（LED）的放大镜来改良VIA（改良VIA，VIA-Md），以研究宫颈上的醋酸白色区域。LED发出的光的峰值波长在蓝白色范围内。以阴道镜引导下活检作为参考标准，比较VIA和VIA-Md的结果。
该研究纳入了273名符合条件的女性。VIA和VIA-Md检测CIN2+病变的灵敏度分别为57.1%和100%。VIA和VIA-Md的特异性分别为99.2%和89.5%；以阴道镜引导下活检作为参考标准时，其似然比分别为0.000和0.018。然而，VIA-Md在阴道镜引导下活检确诊的32例慢性宫颈炎病例中，也有效识别出了21例。
VIA-Md似乎是检测CIN2+病变的一种高度敏感的检测方法。然而，由于对其较低的特异性存在担忧，VIA-Md可与VIA同时使用，作为对需要密切监测或可能从局部消融治疗中获益的女性进行分流的有效工具。
