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。     

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。     

人乳头瘤病毒检测与薄层液基细胞学技术在宫颈癌筛查中的应用

目的:了解青岛市崂山区妇女生殖道高危型人乳头瘤病毒(HPV)的感染状况,探讨HPV DNA检测(HC2)与薄层液基细胞学技术(LCT)在宫颈癌筛查中的应用。方法:以崂山区35~64岁妇女为研究对象,8000例行LCT检测,对LCT≥宫颈不典型鳞状上皮细胞(ASC-US)的女性进行阴道镜检查及宫颈活体组织检查;3633例行HPV联合LCT检测,对HPV(+)且LCT≥ASC-US,以及LCT(-)但HPV高负荷量(HPV≥1000pg/ml且年龄40岁或HPV≥100pg/ml且年龄≥40岁)的女性进行阴道镜检查及宫颈活体组织检查。两组均以组织病理学结果为最终诊断。结果:LCT组中133例行病理检查:18例CINⅠ、18例CINⅡ、19例CINⅢ、19例宫颈癌,CINⅡ+检出率为0.7%。HPV联合LCT组中,HPV阳性检出率为13.16%;98例行病理检查,其中HPV(+)且LCT≥ASC-US的病理检查67例,LCT(-)但HPV高负荷量者病理检查31例。病理结果:22例CINⅠ、6例CINⅡ、17例CINⅢ、10例宫颈癌,CINⅡ+检出率为0.9%。HPV联合LCT组的病理阳性检出率(1.51%)明显高于LCT组(0.93%),差异有统计学意义(P0.05)。结论:HPV联合LCT法进行宫颈癌筛查有助于发现宫颈病变高危人群,降低单独采用细胞学进行筛查的漏诊率,值得临床推广应用。     

不同方法检测HPV的临床效果评价

目的 探讨宫颈癌筛查中,不同方法检测HPV的临床效果.方法 选择2011年8-11月在中日友好医院行宫颈癌筛查的妇女424例,均行宫颈脱落细胞的液基细胞学检测(LCT)、第二代杂交捕获HPV检测(HC-Ⅱ)和核酸实时荧光PCR同时对HPV16和HPV18进行分型检测(PCR12+2).检测结果分两组进行评价:HC-Ⅱ组(LCT联合HC-Ⅱ),共计424例;PCR12+2组(LCT联合PCR12+2),剔除3例脱落病例,共计421例.两组均对LCT结果在未明确诊断意义的不典型鳞状上皮细胞(ASCUS)及以上和(或)高危型HPV阳性者行阴道镜活检及组织病理学检查.此外,PCR12+2组同时还对LCT阴性,但HPV 16或18阳性者行阴道镜活检及组织病理学检查.结果 (1)两组患者中,组织病理学检查结果≥宫颈上皮内瘤变Ⅱ级(CINⅡ)病变的筛查结果比较,差异无统计学意义(x2=3.35,P＞0.05).HC-Ⅱ和PCR12+2用于筛查≥CINⅡ病变的敏感度、特异度、阳性预测值和阴性预测值分别为:77.8％,79.4％,20.4％,98.1％和96.3％,78.2％,23.2％,99.7％.(2)在PCR12+2组中,HPV16阳性34例,HPV18阳性5例(其中1例同时HPV16阳性),其他高危型HPV阳性74例,阴性309例.其中HPV16和(或)HPV18阳性比其他高危型HPV阳性导致组织病理学≥CINⅡ病变的风险更高,分别为51.3％ (20/39)和8.1％ (6/74).(3)在PCR12+2组中,HPV16阳性、HPV18阳性、其他高危型HPV阳性及HPV阴性者的致癌风险比较,差异有统计学意义(x2=93.98,P＜0.01).结论 LCT联合PCR12+2检测用于筛查宫颈癌,可以鉴别出宫颈病变≥CINⅡ风险更高的患者.     

阴道镜检查在宫颈病变筛查中的应用价值

目的 分析在宫颈病变筛查中应用阴道镜检查的临床价值。方法 选取符合阴道镜检查指征的200例疑似宫颈病变患者,患者均接受阴道镜检查+活检,以病理诊断结果为金标准,评估阴道镜检查的诊断符合率。结果 200例患者经病理确诊炎症121例,CINⅠ级52例,CINⅡ～Ⅲ级24例,宫颈癌3例,阴道镜检查符合率分别为77.69%、86.54%、79.17%、100%,总符合率为80.50%。与病理诊断结果相比,阴道镜诊断宫颈炎症符合率差异有统计学意义（P<0.05）,但对CINⅠ级、CINⅡ～Ⅲ级及宫颈癌的诊断符合率比较,差异无统计学意义（P>0.05）。结论 阴道镜检查在宫颈疾病筛查诊断中,尤以宫颈癌、CIN的诊断效果较好,可作为宫颈病变早期筛查诊断的参考依据。     

不同子宫颈癌筛查方案应用价值评价

目的评价不同方案进行宫颈癌筛查的临床应用价值。方法 2008年7月至2010年2月在中日友好医院妇科门诊同时采用宫颈液基细胞学检查（liquid-based cytologic test,LCT）和高危型人乳头瘤病毒（HR-HPV）筛查宫颈癌妇女1052例,对LCT提示≥ASC-US或HR-HPV阳性者或醋酸试验阳性者进行阴道镜下宫颈活组织检查,以病理结果为金标准评价LCT、HPV、LCT＋HPV平行试验、LCT-HPV系列试验、HPV-LCT系列试验5种方案筛查宫颈高度病变的价值。结果 LCT、HPV、LCT＋HPV平行试验、LCT-HPV系列试验与HPV-LCT系列试验筛查宫颈癌的敏感性分别为73.86%、93.18%、98.86%、90.34%和86.93%;特异性分别为90.87%、77.74%、71.57%、83.79%和86.76%;阳性预测值分别为61.90%、45.68%、41.13%、52.82%和56.88%;阴性预测值分别为94.54%、98.27%、99.68%、97.74%和97.06%;各筛查方案诊断价值相近,差异均无统计学意义（P〉0.05）;LCT-HPV系列试验的各项价值与LCT＋HPV平行试验相近,费用效益比更为理想。结论 LCT-HPV系列试验在获得良好筛查价值的同时显著降低了宫颈癌初筛的费用。     

北京社区妇女3年内宫颈病变初次及再次筛查结果分析

目的本研究通过对北京市社区妇女3年的随访资料,研究北京社区妇女宫颈病变的状况。方法 2006年和2009年分别对北京市西城区展览路社区225名20～54岁有性生活的妇女,用相同的方法进行宫颈病变初次筛查及再次筛查。应用液基细胞学（LCT）、高危型人乳头状瘤病毒（HPV）检测,对宫颈细胞学异常（≥ASC-US）者行阴道镜及活检病理检查,并将两次筛查结果进行分析。结果①2006年初筛细胞学异常者15例,其中HPV阳性者9例。2009年再次随访筛查,细胞学异常者7例,细胞学阴性者218例;②细胞学变化：细胞学转阴者14例（14/225）,除2例（1例湿疣、1例CIN2）经激光治疗及2例CIN3行宫颈锥切术外,其余10例均未予干预。细胞学转阳者6例（6/225）,其中发现1例湿疣及3例慢性宫颈炎,其余2例拒绝阴道镜检查。细胞学均阳性者1例（1/225）,HPV结果均为阳性,病理结果为慢性宫颈炎。细胞学均阴性者为204例;③HPV检测结果及变化：两次筛查HPV阳性者34例（15.1%）。HPV均阴性者178例（79.1%）。结论在北京社区妇女宫颈病变的筛查中,细胞学及HPV均阳性者,宫颈病变的可能性大。对病变妇女应尽早干预并建议进行包括HPV检测的定期随访追踪。     

液基细胞学在宫颈病变筛查中的诊断评价

近年来,宫颈癌的发病率逐渐提高,并呈年轻化趋势。宫颈上皮内瘤变（CIN）是宫颈癌的癌前病变,及时准确诊治CIN是预防宫颈癌的有效手段。随着液基细胞制片技术在宫颈病变筛查中的广泛应用,宫颈病变检出率明显提高。本文采用宫颈液基薄层细胞学技术（LCT）,结合宫颈细胞学诊断的报告系统（TBS）,联合阴道镜下活检的方法对2005年1月至2007年10月在山东省青岛市立医院就诊的6156例患者进行回顾性分析,进一步评价LCT在宫颈病变筛查中的应用价值。     

改良取样巴氏涂片在人群子宫颈癌筛查中的应用

目的：探讨改良取样巴氏涂片（Pap）在子宫颈癌筛查中的应用价值。方法：对500例30~59岁、3年内未行宫颈癌筛查的妇女行改良Pap、液基细胞学（LCT）和第二代杂交捕获实验（HC-Ⅱ）人乳头瘤病毒（HPV）检测,Pap采用液基细胞学刷取样,2种细胞学取样采用分配样本法。细胞学以无明确诊断意义不典型鳞状细胞（ASCUS）为阳性阈值,对任一细胞学结果或HPV检测阳性的妇女行阴道镜下宫颈多点活检,以病理诊断为金标准,评价2种细胞学方法筛查宫颈癌的价值。结果：宫颈细胞学筛查宫颈上皮内瘤样病变（CIN）Ⅱ以上病变以ASCUS为阳性阈值的筛查效率最高;改良Pap和LCT的筛查效率（ROC曲线下面积比较,Z ＝0.70,P ＞0.05）和不满意率（χ2＝0.343,P =0.558）差异无统计学意义;两种细胞学的诊断完全一致率为86.8%,宫颈癌和宫颈癌前病变级别越高,2种细胞学方法判读结果的一致性越好。结论：改良Pap经济有效,可广泛应用于人群子宫颈癌筛查。     

HPV感染年龄与高度宫颈上皮内瘤变的关系

目的探讨高危型人乳头瘤病毒（HR-HPV）感染患者年龄分布与高度宫颈上皮内瘤变和宫颈癌的关系。方法 2008年7月至2009年4月在中日友好医院同时采用液基薄层细胞学（LCT）和HPV检测行宫颈癌筛查的妇女948例,对LCT≥ASC-US和/或HR-HPV阳性的367例患者进行阴道镜下宫颈活检。结果 〈50岁年龄组妇女的HR-HPV感染率（34.27%）与≥50岁年龄组妇女（18.98%）比较,差异具有统计学意义（P〈0.01）;〈30岁、30～49岁和≥50岁3个年龄组HR-HPV阳性者中,≥CIN2患者的例数分别为18例（39.13%）、81例（43.78%）和17例（32.69%）,差异无统计学意义（P〉0.05）。结论各个年龄段感染HR-HPV的妇女发生≥CIN2的机会无明显差异,均应加强随访。     

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。     

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2003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VIU做宫颈癌初筛的方案可行。     

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.     

Cervical cancer screening with naked-eye visual inspection in Colombia

Objective

To assess the accuracy of visual inspection provided by nurses through combining acetic acid (VIA) and Lugol's iodine (VILI) in a low-resource region of Colombia.

Methods

A cross-sectional study with 4957 women was conducted to evaluate visual inspection techniques as the basis for see-and-treat approaches in cervical cancer control. All women underwent conventional cytology, VIA performed by nurses, and a combination of VIA and VILI. All women underwent colposcopy and biopsies were obtained for any positive test.

Results

A total of 762 women underwent biopsy, 4945 women were included in the analysis of conventional cytology, and 4957 were included in the analysis of VIA and VIA-VILI. Positivity rates were 1.3% and 4.3% for HSIL and LSIL cytology, 7.4% for VIA, and 10.1% for VIA-VILI. Sensitivity for cytology was 52.9% and 36.8% for LSIL and HSIL thresholds, 53.6% for VIA, and 68.1% for VIA-VILI. The corresponding specificity was 95.0%, 99.2%, 93.2%, and 90.8% respectively. The parallel combination of VIA-VILI and cytology LSIL-threshold revealed the best performance as a screening strategy.

Conclusion

The use of VIA-VILI simulating colposcopic procedures and provided by nurses represents a good alternative for implementing see-and-treat programs in Latin America. Program constraints should be taken into account.     

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。     

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 screening in rural North India

Objective

To assess the accuracy of cervical screening with visual inspection and cytology testing, and the cure rate of cervical intraepithelial neoplasia (CIN) after treatment, in a rural population in North India.

Methods

A cross-sectional study evaluated the detection rates of CIN 2 and CIN 3 lesions by cytology testing and by visual inspection of the cervix following the application of 5% acetic acid (VIA) or Lugol's iodine (VILI). It also evaluated the cure rates following treatment of CIN.

Results

Of 5050 women approached in 17 villages, 3000 (59.4%) participated (range, 41%-91%). Of these, 14.2% were positive by VIA, 15.6% by VILI, and 5.4% by cytology testing at ASCUS threshold, and 37 women were diagnosed as having CIN 1 and 20 as having CIN 2 or CIN 3. Detection rates of CIN 2 or 3 using VIA, VILI, and cytologic findings of ASCUS and LSIL were 3.7, 3.3, 4.5, and 4.2 per 1000 women, respectively, and 91.4% of the treated women were cured.

Conclusion

Both VIA and VILI were found to be accurate screening tests and the cure rates for CIN were satisfactory.     

Trends in cervical cancer screening in developing countries

Developing countries suffer the highest burden of cervical cancers but have the lowest resources. Effective cervical cytology screening programme, along with a network of diagnostic and therapeutic colposcopy centres, like developed countries, is almost impossible to be reproduced in developing countries. Visual inspection methods [e.g., Visual inspection with Lugol’s iodine (VILI) and Visual Inspection with Acetic Acid (VIA)] which are cheaper, require less expertise and have the advantage of possible treatment in one setting have been shown to be effective alternatives. The sensitivity to detect CIN2+, by VIA and VILI, have been shown to be 80% and 91% respectively, with a specificity rate of 92% and 85% respectively. Screening by human papillomavirus (HPV) testing has high sensitivity (96.4%) but low specificity (94.1%) to detect CIN2+, when compared to Pap Smear (sensitivity, 55.4% and specificity, 96.8%). A single lifetime HPV testing in a large unscreened population has been shown to significantly reduce cervical cancer incidence and mortality when compared to cervical cytology, VIA or no screening. HPV testing of self-collected vaginal specimens also helps to overcome religious and socio-cultural barriers towards pelvic examination amongst women in developing countries. Current HPV testing methods are expensive, skill/infrastructure demanding and takes time to produce results. A cheaper HPV test, called careHPV™, which is able to provide results within 2.5 h and requires minimal skill/infrastructure to operate, was designed for use in developing countries. One stop screen and treat facilities using VIA or rapid HPV testing, and cryotherapy, can overcome non-compliance to follow-up which is a major issue in developing countries. Cure rates of 81.4% for CIN1, 71.4% for CIN2 and 68.0% for CIN3 at 6 mo after treatment have been reported. Incorporating telemedicine with cervicography of VIA or VILI or even telecolposcopy, has great potential in cervical cancer screening, especially in countries with vast geographical areas.     

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.