Megevand E, Denny L, Dehaeck K, Soeters R, Bloch B
Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, Republic of South Africa.
Obstet Gynecol. 1996 Sep;88(3):383-6. doi: 10.1016/0029-7844(96)00189-5.
To investigate the value of acetic acid visualization of the cervix as an alternative to cytologic screening.
A prospective study was conducted in a squatter area in Cape Town, South Africa, on 2426 women who underwent speculum examination, naked-eye inspection of the cervix after application of acetic acid, and cytologic smear. The smears were stained and processed at the screening site. Patients with a positive reading after acetic acid or a smear indicating a high-grade squamous intraepithelial lesion (SIL) were referred for immediate colposcopy, biopsy, and when indicated, treatment by large loop excision of the transformation zone. Therefore, histology was obtained on all patients with a positive acetic acid test or a positive cytology.
Seventy-six women with positive reactions to acetic acid. Among the 2350 women with negative reactions, 254 had positive cervical smears; only 11 of these had histologic high-grade SIL. In contrast, 20 of the 61 women with positive cytology and positive acetic acid test had high-grade SIL on histology. Therefore, the acetic acid reaction enabled the observer to detect 20 of the 31 women (64%) who exhibited a high-grade SIL both on cytology and histology.
In locations where access to cytopathology is limited, naked-eye visualization of the cervix after application of diluted acetic acid warrants consideration as an alternative in the detection of cervical premalignant lesions.
探讨宫颈醋酸可视化作为细胞学筛查替代方法的价值。
在南非开普敦的一个棚户区对2426名妇女进行了一项前瞻性研究，这些妇女接受了窥器检查、涂抹醋酸后肉眼观察宫颈以及细胞学涂片检查。涂片在筛查地点进行染色和处理。醋酸检查结果为阳性或涂片显示高级别鳞状上皮内病变（SIL）的患者被立即转诊进行阴道镜检查、活检，并在必要时通过转化区大环状切除术进行治疗。因此，对所有醋酸试验阳性或细胞学检查阳性的患者均进行了组织学检查。
76名妇女醋酸反应呈阳性。在2350名反应阴性的妇女中，254名宫颈涂片呈阳性；其中只有11名有组织学高级别SIL。相比之下，61名细胞学检查阳性且醋酸试验阳性的妇女中有20名组织学检查为高级别SIL。因此，醋酸反应使观察者能够在31名细胞学和组织学检查均显示高级别SIL的妇女中检测出20名（64%）。
在获取细胞病理学检查受限的地区，涂抹稀释醋酸后对宫颈进行肉眼观察值得作为检测宫颈癌前病变的一种替代方法加以考虑。
