肉眼观察法在宫颈癌及癌前病变筛查中的应用

目的：探讨醋酸肉眼观察（VIA）和碘染色肉眼观察（VILI）在宫颈癌及癌前病变筛查中的可行性。方法：以天津市大港区2 003例妇女为研究对象,进行癌症综合知识、危险因素的问卷调查,用VIA和 VILI行宫颈癌及其癌前病变筛查。VIA或VILI阳性者行电子阴道镜检查,阴道镜检查异常者行阴道镜下宫颈活检,病理学检查明确诊断。结果：单纯VIA阳性者257例,VIA或VILI阳性者共计265例,其中197例阴道镜检查异常,在阴道镜指导下行宫颈活检,以病理学检查结果作为诊断的金标准,宫颈上皮内瘤变（CIN）的检出率为7.04%,其中CINⅠ116例,CINⅡ14例,CINⅢ11例。结论：在资源有限、经济欠发达的地区,由经过培训的医生实施VIA或VILI做宫颈癌初筛的方案可行。     

内蒙古少数民族地区宫颈癌的筛查方法研究

目的探讨内蒙古少数民族聚居区宫颈癌及癌前病变适宜的筛查方法。方法2009年4月-8月对内蒙古自治区鄂尔多斯、兴安盟、通辽三个地区的2958名年龄30～59岁的已婚妇女进行了宫颈癌筛查。取宫颈脱落细胞,做人乳头瘤病毒（HPV-HC2）检测;同时用醋酸着色及碘着色（VIA/VILI）肉眼观察的方法进行筛查。对HPV-HC2阳性或VIA/VILI肉眼观察异常或两者均异常者,行阴道镜检查,在可疑处取宫颈组织活检,必要时行颈管诊刮术（ECC）;送组织病理学检查确诊。结果内蒙古鄂尔多斯、通辽、兴安盟三地区HPV总感染率为17.36%,中度及以上宫颈上皮内瘤样病变（≥CIN2）和宫颈癌的检出率为0.9%;应用HPV-HC2筛出阳性者最后确诊≥CIN2者27例,而用VIA/VILI仅确诊13例,漏诊14例。结论HPV检测结合醋酸、碘肉眼观察是宫颈癌筛查的有效方法。在内蒙等经济发展不均衡地区,可尝试采用HPV检测进行初筛,对HPV阳性患者用VIA＋VILI或者细胞学筛查的方法进行分流的筛查策略,降低漏诊率,也相对降低HPV阳性患者阴道镜的转诊率。     

醋白肉眼观察试验在宫颈病变筛查中的价值

目的以宫颈细胞学、阴道镜检查及活检的诊断结果为标准，评价宫颈醋白肉眼观察试验（vision inspection with acetic acid，VIA）在宫颈病变筛查中的价值。方法2006年6月～7月对北京市展览路社区的790位20～54岁有性生活妇女进行宫颈病变筛查。采取每名妇女的宫颈脱落细胞，留做薄层液基细胞学（LCT）检测，然后应用5％醋酸涂抹法，进行宫颈醋白肉眼观察试验（VIA），VIA阳性者行阴道镜检查及活检病理检查；VIA阴性者若宫颈细胞学检测结果异常，再行阴道镜检查及活检病理检查。结果最终有783人纳入试验诊断效果评价分析，总共取了71例活检，病理组织学检查结果显示，宫颈早期浸润癌1例，CINⅢ4例，CINⅡ3例，CINⅠ12例。VIA方法筛查CINⅡ及以上宫颈病变和宫颈癌的灵敏度为62．5％，特异度为95．9％，阳性预测值为13．5％，阴性预测值为99．6％。结论醋白肉眼观察试验筛查宫颈病变的效率接近传统巴氏涂片，但因其方便快捷、价格低廉，在经济不发达地区或低收入人群中有一定应用价值，但是需要注意漏诊和过度治疗问题。     

电子阴道镜在宫颈癌筛查中的应用

目的：使用阴道镜筛出癌前病变及肉眼不能发现的早期宫颈癌,指导活检,提高活检和诊断的准确率,做到早发现,早诊断,早治疗。及时进行癌前阻断,从而降低发病率和死亡率。方法：用电子阴道镜对3722例农村妇女进行宫颈癌筛查,其中对2672例绝经前妇女行常规电子阴道镜检查,发现异常即在阴道镜下定点行组织活检。结果：256例检查结果中,发现异常147例,异常率51．42％,其中98例为CIN1,18例为CIN2,14例为CIN3,5例为原位癌,12例为尖锐湿疣。镜下定位活检100％。结论：阴道镜筛查能有效筛查宫颈癌及宫颈上皮内瘤病变,是提高宫颈癌筛查诊断的重要手段。电子阴道镜在宫颈癌筛查中具有低成本、高效益的特点,即有一定的临床价值和经济价值。     

醋酸-碘试验在宫颈癌早期筛查中的价值

目的：评价宫颈醋酸－碘试验（VIA-VILI）筛查宫颈癌早期病变的价值。方法：2008年5月—9月对天津市大港区迎新街社区的2 006例30~59岁有性生活妇女进行宫颈癌早期病变筛查。采集宫颈脱落细胞留做薄层液基细胞学（LCT）检测。然后应用5%醋酸及希乐液涂抹法进行VIA-VILI,VIA-VILI阴性而LCT结果异常者、VIA阳性者或VILI阳性者行阴道镜检查及活检病理检查。结果：最终有2 000例纳入试验,VIA-VILI阳性并取活检347例,病理结果显示≥CINⅡ者47例（占13.54%）;LCT阳性并取活检134例,病理结果显示≥CINⅡ的50例（37.31%）,其中39例为VIA-VILI及LCT均为阳性者。筛查CINⅡ及以上宫颈病变和宫颈癌的敏感度、特异度和约登指数,VIA-VILI方法分别为81%、84.6%和0.656,LCT检查分别为90.3%、88.4%和0.787。结论：VIA-VILI试验筛查宫颈病变的效率虽低于LCT检查,但方便快捷、价格低廉,在经济不发达地区或低收入人群中有一定应用价值。     

巴氏涂片结合醋酸白试验肉眼观察在宫颈癌普查中的应用

目的 探讨运用巴氏涂片结合醋酸白试验肉眼观察进行宫颈癌筛查。方法 巴氏Ⅱ级以上者、醋酸白试验肉眼观察阳性者，均行阴道镜检查，并做多点活检、组织学诊断。将二者结合综合分析。结果 巴氏涂片结合醋酸；肉眼观察（VIA）在官颈癌普查中互为弥补，CIN的诊断准确率可提高20％～35％。结论 此方法费用低，易操作，适合边远贫困地区大范围宫颈癌普查，值得推广。     

醋酸白及碘试验肉眼观察法在农村妇女宫颈癌筛查中的作用

目的探讨醋酸白及碘试验肉眼观察法在宫颈癌筛查中的意义。方法 2008年3月至10月应用醋酸白及碘试验肉眼观察法(VIA/VILI)对华北地区6县市(北京大兴区、天津大港区、河北赤城和曲周、山西襄垣和沁县)6地区部分生育年龄农村妇女进行宫颈癌筛查,对阳性者行阴道镜检查,如异常取活检病理学检查,确诊病变者依据早诊早治技术方案进行治疗。结果 6地区共筛查12208例,大兴、大港、赤城、曲周、襄垣、沁县:VIA/VILI阳性率分别为11.50%、17.95%、21.88%、6.19%、2.95%、6.11%;阴道镜检查的活检率分别为80.43%、83.33%、8.26%、48.00%、100.00%、74.40%;活检病例中宫颈高度以上病变所占比例分别为6.49%、15.67%、18.42%、1.67%、18.33%、21.51%;VIA/VILI对宫颈高度以上病变检出率分别为5.22%、13.06%、1.52%、0.80%、18.33%、16.00%。结论不同地区醋酸白及碘试验肉眼观察法在应用和推广中存在一定的局限性,应予以重视。     

延安市宫颈癌机会性筛查应用研究

目的探讨延安市宫颈癌机会性筛查的应用价值。方法：2012年1月至2013年9月在延安市人民医院妇科门诊就诊的患者自愿行宫颈癌机会性筛查,以液基细胞学检查、高危型人乳头瘤病毒检测和阴道镜为筛查方法,宫颈活检组织病理学结果为最终诊断标准,探讨机会性筛查对宫颈癌早期发现、早期治疗的意义。结果：3000例患者全部行TCT检查,阳性检出率为16．17％（485／3000）;3000例患者中同时行HPV检测者有1475例,感染率为25．90％（382／1475）：468例患者在阴道镜下行宫颈活检术,病理结果为：CIN I 82例、CINⅡ～Ⅲ 46例、SCC 9例。结论：通过机会性筛查可以更好地提高防治效果,对宫颈癌的早诊早治有着非常重要的意义,值得推广应用。     

TCT、HPV检测联合阴道镜下宫颈活检在宫颈癌前病变及宫颈癌诊断中的应用价值

目的 探讨液基薄层细胞检测（TCT）、人乳头瘤病毒（HPV）联合阴道镜下宫颈活检诊断宫颈癌前病变与宫颈癌的价值。方法 选取120例疑似宫颈病变患者为研究对象,以组织病理学检查为金标准,分析TCT、HPV、阴道镜下宫颈活检诊断宫颈癌前病变及宫颈癌的价值。结果 120例疑似宫颈病变患者中,组织病理学检查检出阳性69例;以组织病理学检查结果为金标准,TCT、HPV联合阴道镜下宫颈活检诊断宫颈癌前病变与宫颈癌灵敏度、准确度高于单独诊断,差异有统计学意义（P<0.05）;kappa检验显示,TCT、HPV联合阴道镜下宫颈活检检查结果与金标准的一致性极好（kappa=0.949,P<0.05）。结论 TCT、HPV联合阴道镜下宫颈活检能够诊断出宫颈癌前病变与宫颈癌,具有一定的诊断效能。     

阴道镜在宫颈癌筛查中的应用价值

目的探讨阴道镜在定期宫颈癌筛查中的应用价值。方法选取2014年我区35~64岁已婚妇女进行免费宫颈癌筛查选出598例进行阴道镜检查。结果共发现宫颈上皮内瘤变43例(其中宫颈刮片阳性22例,其他21例),乳头状瘤病毒HPV70例,慢性宫颈炎110例。结论阴道镜+宫颈活检是宫颈癌及癌前病变筛查中必要及有效的方法,特别对于宫颈刮片阴性,肉眼观察可疑异常的妇女应建议行阴道镜检查,以便早期发现癌前病变,提高筛查率。     

Analysis of the effectiveness of visual inspection with acetic acid/Lugol’s iodine in one-time and annual follow-up screening in rural China

Purpose

Via a large population-based survey conducted in rural, southwestern China, we aim to evaluate the effect of visual inspection with acetic acid/Lugol’s iodine (VIA/VILI) on diagnosing cases of cervical cancer and of pre-cancerous lesions while exploring the mode of cervical prevention and control in low-resource settings in China.

Methods

Women aged 30–59?years from Chongqing, China were recruited from 2006 to 2009. Participants underwent VIA/VILI, and, if positive, received colposcopy-directed or random biopsies. Women with negative VIA/VILI or biopsy-confirmed cervical intraepithelial neoplasia (CIN) 1 lesions diagnosed in the first round of screening were re-screened in the following year with the same procedure.

Results

In total, 10,269 women received VIA/VILI. The average age of participants was 40.9?±?7.6?years. Overall, 0.85% (87/10,269) of women were diagnosed via pathology-confirmed biopsy with CIN1, 0.25% (26/10,269) with CIN2, 0.27% (28/10,269) with CIN3, and 0.02% (2/10,269) with cervical cancer. Over half (57.7%) of CIN2 lesions, the majority of CIN3 lesions (89.3%), and all cancer cases (100%) were detected in the first round of screening.

Conclusion

In a rural, low-resource setting in China, one-time VIA/VILI screening detected more than a half of CIN2 cases, most CIN3 cases and all the cervical cancer cases. Detection rates of CIN2 lesions significantly increased with a 1-year follow-up VIA/VILI screen. Therefore, if multiple cervical cancer screenings are not feasible logistically or financially, a one-time VIA/VILI may be the most efficient strategy to detect cervical cancer and most CIN3 lesions in women in low-resource settings.     

Visual screening for early detection of cervical neoplasia in Angola

Objective

A cross-sectional study in Angola to evaluate the feasibility of cervical screening using visual inspection with acetic acid (VIA) or Lugol's iodine (VILI) to detect and treat cervical intraepithelial neoplasia (CIN).

Methods

All 8851 women screened by trained nurses received colposcopy and/or colposcopically-directed biopsies. The final disease status was based on histopathology or colposcopy when no or inadequate biopsies were done. The sensitivity, specificity, and predictive values of tests to detect CIN 2-3 were calculated.

Results

VIA was positive in 6.6% and VILI in 32.0% of the women. The positivity rates increased with time only for VILI. CIN 2-3 was diagnosed in 75 women and invasive cancer in 57. The sensitivity and specificity was 70.7% (95% CI, 59.0%-80.6%) and 94.5% (95% CI, 94.0%-95.0%) respectively for VIA, and 88.0% (95% CI, 78.4%-94.4%) and 68.9% (95% CI, 67.9%-69.9%) for VILI. Ninety percent of women detected with CIN received treatment. Treatment was given on the same day as screening to one-third of the 374 women treated with cryotherapy/LEEP. No major complications or adverse effects were associated with treatment.

Conclusion

It was feasible to screen with both visual tests and treat women with CIN in Angola. VILI was less specific than VIA, implying subjectivity in interpreting test results.     

Evaluation of cervical visual inspection screening in Dar es Salaam, Tanzania

Objective

To evaluate the feasibility and performance of screening for cervical cancer using visual inspection with acetic acid (VIA) or with Lugol's iodine (VILI) in Dar es Salaam, Tanzania.

Methods

The accuracy of tests for detecting cervical intraepithelial neoplasia (CIN) was assessed in a cross-sectional study of 10 378 women. All women who were screened underwent colposcopy, and biopsies were offered to those with abnormal colposcopy results.

Results

The positivity rates were 3.8% for VIA and 4.8% for VILI. The peak positivity rates for both visual tests were observed just after training or re-training and gradually declined thereafter. CIN 1 was diagnosed in 41 women, CIN 2-3 in 33 women, and invasive cancer in 200 women, showing high detection rates of invasive cancer. The sensitivity and specificity for the detection of CIN 2-3 lesions were 60.6% (95% confidence interval [CI], 42.1-77.1) and 98.2% (95% CI, 97.9-98.4), respectively, for VIA; and 93.9% (95% CI, 79.8-99.3) and 97.3% (95% CI, 97.0-97.6), respectively, for VILI. Two-thirds of the women detected with CIN 2-3 lesions were treated.

Conclusion

Both visual screening tests are useful and accurate, especially in low-income settings. Standardization of assessment of the visual inspection techniques, continual training and supervision, and quality control measures are important for successful visual screening programs.     

宫颈巴氏涂片与LCT在低收入妇女妇科普查中的应用

目的探讨宫颈巴氏涂片与液基细胞学（LCT）在低收入已婚妇女宫颈癌筛查中的应用价值。方法2008年1月至6月上海市浦东新区妇幼保健院对所在社区6416例低收入已婚妇女（低收入组）采用宫颈巴氏涂片进行了宫颈癌筛查,其中322例同期行LCT,并与同期来上海市浦东新区妇幼保健院做宫颈癌筛查行LCT的294名妇女进行对照（对照组）。结果①宫颈刮片巴氏异常者（≥Ⅱb级）低收入组中22例（0．34％）,其中Ⅱb级12例（0．19％）,Ⅲ级10例（0．16％）,无Ⅳ级及Ⅴ级。15例（Ⅱb5例,其余Ⅲ级）行阴道镜下活检,病理结果CIN8例,其中CIN12例,CIN2和CIN3各3例;②低收入组同期行LCT的322例妇女中,细胞学≥ASCUS共41／322例（12．73％）,其中ASCUS15例,HSIL 1例,行阴道镜下活检病理结果CIN5例（CIN1和CIN2各2例,CIN31例）;HSIL1例为子宫颈鳞状细胞癌。对照组：细胞学≥ASCUS 22／294例（7．48％）。其中ASCUS 11例行阴道镜下活检。病理结果仅CIN 21例;2例LSIL;1例为CIN2。两组AGC各1例经阴道镜下活检均无异常;③低收入组中322例行宫颈刮片和LCT做自身对照：315例巴氏均为Ⅰ级,LCT正常;巴氏Ⅱb级2例,LCT均为ASCUS,病理分别为CIN1和CIN2;巴氏Ⅲ级3例,LCT检查,其中2例为ASCUS,阴道镜活检仅1例病理为CIN2。结论宫颈细胞学是筛查宫颈病变的有效手段,巴氏涂片法在基层对低收入人群仍可为主要筛查方法。有条件者可采用LCT,以提高宫颈疾病筛查的敏感性。     

内蒙古镶黄旗地区妇女宫颈病变筛查现状

目的探讨宫颈细胞学(包括巴式涂片及超柏氏薄层液基细胞学)及阴道镜检查筛查内蒙古镶黄旗地区妇女宫颈病变的现状及临床意义。方法2004年7月至2009年1月对内蒙古镶黄旗地区的642例28～67岁有性生活妇女进行宫颈病变筛查,其中557例妇女行传统宫颈巴式涂片法,85例妇女行宫颈超柏氏薄层液基细胞学,并对宫颈细胞学异常者(≥ASCUS)行阴道镜检查及活检。结果642例妇女中宫颈细胞学阳性(≥ASCUS)者34例,占5.3%(34/642),其中ASCUS者22例,占64.7%(22/34);低度鳞状上皮内病变(LSIL)者6例,占17.6%(6/34);高度鳞状上皮内病变(HSIL)者6例,占17.6%(6/34),其中有1例肯定为宫颈癌。宫颈细胞学阴性608例,占94.7%(608/642)。宫颈细胞学阳性34例人群中,行阴道镜活检病理检查者有25例,其中慢性宫颈炎13例(52.0%);CIN1为5例(20.0%);CIN2为4例(16.0%);CIN3为1例(4.0%);浸润癌为2例(8.0%)。结论应重视并及时进行经济不发达地区妇女人群宫颈病变的早期筛查,传统宫颈巴式涂片法及阴道镜活检及病理学检查为可行的筛查方法,有条件者可进行宫颈薄层液基细胞学结合阴道镜活检及病理学检查,对提高早期宫颈癌筛查的准确性效果明显。对内蒙古等西部地区,应在完善技术力量支持、筛查质量控制、建立筛查后的转诊制度及治疗的绿色通道等方面,以降低宫颈癌的发病率。     

Colposcopy

Though in the 1980s, colposcopically-directed biopsy excluded over 90% of CIN 3 and cancer (CIN 3+), recent reviews found sensitivity of colposcopically-directed biopsy for CIN 3+ of 50-65%. Studies from China showed that the sensitivity of colposcopically-directed biopsy for CIN 3+ is higher for large CIN 3+ than for small CIN 3+ and higher for associated high-grade cervical cytology than for low-grade cervical cytology. Colposcopically-directed biopsy excluded over 90% of CIN 3+ in the 1980s because colposcopy clinics in the 1980s evaluated women with high-grade cytology that had large CIN 3+; it no longer excludes CIN 3+ well because current colposcopy clinics evaluate women with low-grade cytology that have small CIN 3+. When colposcopically-directed biopsy is used to exclude CIN 3+ our understanding of the natural history of CIN is skewed, errors occur in defining appropriate screening practice, and inaccurate diagnosis results in incorrect treatment. The impression that CIN is more common on the anterior lip of the cervix is an artifact introduced by the inaccuracy of colposcopy. An unjustified enthusiasm for screening with acetic acid aided visual inspection (VIA) occurred when the sensitivity of VIA for CIN 3+ was inflated by screening studies using colposcopically-directed biopsy as the gold-standard for CIN 3+. To limit the harm of inaccurate diagnosis associated with colposcopically-directed biopsy, at colposcopy we advise random biopsies at the squamocolumnar junction in cervical quadrants without visible lesions and, unless the woman is pregnant, endocervical curettage (ECC). As the diagnosis of CIN 3+ solely by ECC is uncommon in women under age 25, the ECC may be omitted in women under age 25 years. If multiple cervical biopsies are performed, to limit discomfort, a bronchoscopy biopsy instrument which obtains 2-mm biopsies should be used.     

阴道镜联合HPV检测对提高宫颈病变筛查准确率的影响

目的 探讨应用阴道镜联合人乳头状瘤病毒(HPV)检测对于宫颈病变筛查准确率的影响.方法 选取200例接受宫颈病变筛查妇女,均进行HPV检测联合阴道镜检查,对于检查异常情况进一步做宫颈活检病理组织检查,将病理检查结果作为诊断金标准,分析采取阴道镜联合HPV检测对于疾病筛查准确率的价值.结果 经病理组织检查,200例受检者...