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碘染色肉眼观察作为宫颈癌初筛方法的效果评价
引用本文:李霓,马聪萍,孙立新,张永贞,邵淑丽,邢菊霞,鲍彦平,黄瑞德,贺立绩,乔友林.碘染色肉眼观察作为宫颈癌初筛方法的效果评价[J].中华流行病学杂志,2006,27(1):15-18.
作者姓名:李霓  马聪萍  孙立新  张永贞  邵淑丽  邢菊霞  鲍彦平  黄瑞德  贺立绩  乔友林
作者单位:1. 110001,沈阳,中国医科大学流行病教研室
2. 山西省阳城县肿瘤医院
3. 山西省肿瘤医院
4. 中国医学科学院肿瘤医院流行病室
基金项目:世界卫生组织国际癌症研究所资助项目(FI/92/3-11 CHN)
摘    要:目的评价碘液染色后直接肉眼观察在宫颈癌筛查中的作用,为在现阶段宫颈癌高发且经济落后地区制定宫颈癌及其癌前病变的筛查方案提供依据。方法在山西省阳城县筛查人群中,以病理组织学诊断结果为金标准,利用约登指数比较使用碘液染色后肉眼观察、阴道镜、薄层液基细胞学和人乳头瘤病毒(HPV)DNA的筛查效果。结果该人群(735名)平均年龄为40.80岁±10.7岁,宫颈高度鳞状上皮内瘤样变及癌(≥CINⅡ)的现患率为4.35%(32/735)。以病理组织学结果为金标准(≥CINⅡ),碘液染色后直接肉眼观察的灵敏度和特异度(≥阳性)分别为53.13和82.19,阴道镜的灵敏度和特异度(≥低度病变为阳性)分别为56.25和79.09。运用约登指数进行比较,碘液染色后直接肉眼观察和阴道镜检查之间差异无统计学意义(P>0.05),而碘液染色后直接肉眼观察不如液基细胞学和HPVDNA检测(P<0.05)。另外,经过现场短时间培训后,以前无经验的医生与有经验医生间使用碘液染色的水平的差异无统计学意义(P>0.05)。结论鉴于碘染色后肉眼观察的灵敏度较低,但经济易行,容易掌握,如果能够开展经常性的筛查,可以将碘液染色后直接肉眼观察作为经济落后地区宫颈癌初筛方法之一。

关 键 词:子宫颈癌  筛查  碘液染色后直接肉眼观察
收稿时间:2005-07-21
修稿时间:2005年7月21日

Evaluation on the visual inspection with Lugol's iodine in cervical cancer screening program
Li Ni,Ma Congping,Sun Lixin,Zhang Yongzhen,Shao Shuli,Xing Juxi,Bao Yanping,Huang Ruide,He Liji and Qiao Youlin.Evaluation on the visual inspection with Lugol''s iodine in cervical cancer screening program[J].Chinese Journal of Epidemiology,2006,27(1):15-18.
Authors:Li Ni  Ma Congping  Sun Lixin  Zhang Yongzhen  Shao Shuli  Xing Juxi  Bao Yanping  Huang Ruide  He Liji and Qiao Youlin
Institution:Department of Epidemiology, China Medical University, Shenyang 110001, China.
Abstract:OBJECTIVE: To evaluate visual inspection with Lugol's iodine (VILI) in cervical cancer screening program and to provide evidence for designing a cervical cancer screening algorithm in high risk areas of existing low-resource settings to reduce the incidence and mortality of cervical cancer. METHODS: Women in Yangcheng county, Shanxi province were screened with VILI, colposcopy, liquid-based cytology test and human papilloma virus (HPV) DNA test. The efficacy of different screening tests was compared by Youden's index based on the pathology as the gold standard. RESULTS: In the population being screened, the mean age was 40.80 +/- 10.75 years old. Based on pathological findings, 4.35% (32/735) of the subjects had >or= CIN (cervical intraepithelial neoplasia) II. The sensitivity and specificity for the VILI test (>or= positive) were 53.13 and 82.19, while 56.25 and 79.09 were for colposcopy (>or= low grade dysplasia) respectively. Comparing by the Youden's indexs, there was no statistically significant difference (P > 0.05) between VILI and colposcopy. However, statistical significant difference (P < 0.05) was found between VILI and liquid-based cytology test and HPV DNA test. In addition, there was no statistically significant difference (P > 0.05) found between the experienced doctors and the newly-trained doctors working in the field station. CONCLUSION: With low sensitivity when using microscope but low cost of equipments, VILI can be one of the primary screening tests in China's rural area with low-resource settings if the screening frequency is to be increased.
Keywords:Cervical cancer  Screening  Visual inspection with Lugol's iodine
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