两次醋酸染色肉眼观察在宫颈癌筛查中的价值

目的]探讨两次醋酸染色肉眼观察(VIA)在宫颈癌筛查中的应用价值。方法]2011年对2463名河南省新密市25～65岁的妇女进行HPV检测、VIA的联合筛查,任一筛查阳性者和10%随机抽取的筛查阴性者共855名妇女进行第二次VIA和阴道镜检查。结果]最终完成两次VIA、阴道镜检查及宫颈活检的855名妇女,其中未绝经组561人,绝经组294人。未绝经组和绝经组第一次VIA的阳性率分别为19.8%(111/561)和7.1%(21/294),灵敏度分别为59.1%和20.0%,特异性分别为81.8%和93.6%。未绝经组和绝经组进行第二次VIA的阳性率分别为15.7%(88/561)和5.8%(17/294)。未绝经组和绝经组进行两次VIA检查总的阳性率分别为27.3%和10.2%,两次VIA检查并联的灵敏度分别为81.8%和40.0%,特异性分别为75.0%和91.4%。未绝经组通过两次VIA检查比单独一次VIA检查多发现5例CIN2+的漏诊病例(1例CIN2,4例CIN3),绝经组通过两次VIA检查比单独一次VIA检查多发现3例CIN3的漏诊病例。结论]宫颈癌筛查中,两次VIA检查不仅可以明显提高单次VIA检查的灵敏度,还可以发现单次VIA检查漏诊的高度CIN病例。两次VIA在未绝经女性宫颈癌筛查中的价值优于绝经组。

The Value of Twice Visual Inspection with Acetic Acid in Cervical Cancer Screening

Purpose] To investigate the value of twice visual inspection with acetic acid(VIA) in cervical cancer screening.Methods] In 2011,2 463 unscreened female participants aged 25 to 65 years from Xinmi city,Henan province were recruited and screened with HPV testing and VIA.Any screening test positive and a 10% random samples of negative were referred for a second VIA and colposcopy.Results] In total,855 women completed all the procedures including twice VIA according to the protocol,561 cases in premenopause group and 294 cases in postmenopause group.Of the first VIA,The positive rate in premenopause group and postmenopause group was 19.8%(111/561) and 7.1%(21/294),with the sensitivity 59.1% and 20.0%,the specificity 81.8% and 93.6% respectively.Of the second VIA,The positive rate in premenopause group and post menopause group was 15.7%(88/561) and 5.8%(17/294).The positive rate of twice VIA(any time VIA positive) in premenopause group and postmenopause group was 27.3% and 10.2%,with the sensitivity 81.8% and 40%,the specificity 75.0% and 91.4%,respectively.Five cases CIN2+ women were found by twice VIA in premenopause group,including 1 CIN2 and 4 CIN3,while in postmenopause group,3 cases CIN3 women were found by twice VIA.Conclusion] Twice VIA can improve the sensitivity of a single VIA in cervical cancer screening,in addition,it can find the high grade CIN of single VIA.The value of twice VIA for premenopause women is better than for postmenopause women in cervical cancer screening.