醋白肉眼观察试验在宫颈病变筛查中的价值

Evaluation of vision inspection with acetic acid in cervical lesion screening

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。

Objective To evaluate vision inspection with acetic acid （VIA） in cervical lesion screening. Methotis A total of 790 women at their 20～54 ages, who are living at Zhanlanlu District of Beijing, were screened for cervical lesion. VIA was carried out after sampling of cervical cytology （LCT）. Colposcopy and biopsy were conducted in women with either positive VIA or positive LCT. Results Since 7 women with positive LCT and negative VIA refused to colposcopy and biopsy, 783 women completed the screening and were recruited in the analysis of this study finally. One early invasive cervical cancer, 4 CIN Ⅲ , 3 CIN Ⅱ and 12 CIN Ⅰ were diagnosed pathologically in 71 women. The sensitivity, specificity, positive predictive value and negative predictive value of VIA in screening CIN 11 or sever lesions were 62.5 %, 95.9 %, 13.5 % and 99.6 %, respectively. Conclusions Given its easy deployment and low cost, VIA merit a valuable cervical lesion screening method in low - resource area or low - income population, yet the miss-diagnosis and over-treatment resulted from VIA remain further investigation.