Frisch L E, Milner F H, Ferris D G
Student Health Center, Humboldt State University, Arcata, California 95521.
J Fam Pract. 1994 Nov;39(5):457-60.
The purpose of this study was to assess the predictive value of naked-eye inspection of the cervix (NIC) after acetic acid application as an adjunct to Papanicolaou (Pap) testing for cervical cancer screening.
Study subjects were women attending a medical college student health clinic either for cervical cytologic screening (67%) or because of a recent atypical cytologic screening result (33%). All study participants received cytologic screening, cervicography, and NIC.
Of the 95 patients, 71 (75%) had abnormal findings on NIC. Fifty-one patients underwent colposcopy with biopsy, including 48 of the 71 with an abnormal finding on NIC. The results of 40 of the biopsies were abnormal: 36 showed human papillomavirus or low-grade squamous intraepithelial lesions, 3 showed high-grade squamous intraepithelial lesions, and 1 showed invasive cervical cancer. Sixty-five percent (26) of the abnormal biopsy findings occurred in women with normal cytologic test results. NIC and cervicography both were effective in identifying patients with abnormalities, but the combination of NIC followed by cervicography referred fewer women for colposcopy than did a positive result on NIC alone (52% vs 75%). The combination of a negative Pap smear and a negative NIC result had a 91% predictive value for the absence of cervical intraepithelial neoplasia. This was a significant improvement over cytologic screening alone.
In this study, the combination of cytologic screening (Pap smear) and NIC increased the screening yield as compared with a Pap smear alone but with some loss of positive predictive value. NIC significantly improved the predictive value of negative cytologic screening results.
本研究旨在评估醋酸涂抹后宫颈肉眼检查（NIC）作为巴氏（Pap）检测辅助手段用于宫颈癌筛查的预测价值。
研究对象为到医学院校学生健康诊所进行宫颈细胞学筛查（67%）或因近期细胞学筛查结果异常（33%）前来就诊的女性。所有研究参与者均接受了细胞学筛查、宫颈造影和NIC检查。
95例患者中，71例（75%）NIC检查有异常发现。51例患者接受了阴道镜检查及活检，其中包括NIC检查异常的71例患者中的48例。40例活检结果异常：36例显示人乳头瘤病毒或低度鳞状上皮内病变，3例显示高度鳞状上皮内病变，1例显示浸润性宫颈癌。65%（26例）的活检异常结果出现在细胞学检查结果正常的女性中。NIC和宫颈造影在识别异常患者方面均有效，但先进行NIC检查再进行宫颈造影的联合检查转诊进行阴道镜检查的女性少于仅NIC检查结果阳性者（52%对75%）。巴氏涂片阴性和NIC结果阴性的联合检查对无宫颈上皮内瘤变的预测价值为91%。这比单纯的细胞学筛查有显著改善。
在本研究中，与单纯巴氏涂片相比，细胞学筛查（巴氏涂片）和NIC的联合检查提高了筛查效率，但阳性预测价值有所降低。NIC显著提高了阴性细胞学筛查结果的预测价值。
