五种检测方法在宫颈癌及其前期病变筛查中的准确性评估

Evaluation of five screening methods for an early detection of cervical cancer and its precancerous lesions in Zhejiang province

目的 比较5种现行的筛查方法在宫颈癌高发地区的应用,从而评价出最佳宫颈癌筛查方案,进而在浙江省范围内推广.方法 在浙江省丽水市某社区内计划选取1005名年龄在25～65岁、有性生活的女性进行宫颈癌筛查,筛查手段选择巴氏涂片、液基细胞学、HPV-DNA检测法、肉眼观察辅以醋酸白染色（VIA）和肉眼观察辅以Lugol＇s碘染色（VILI）5种.所有筛查者均接受阴道镜检查,以病理组织学结果为金标准,阴道镜检查无异常作为阴性结果.结果 巴氏涂片对宫颈上皮内高度病变的敏感度、特异度、阳性预测值、阴性预测值分别如下：25%,90%,26.7%,98.6% 液基细胞学的上述指标分别为81.3%,97.3%,35.1%,99.6% VIA上述指标为：68.9%,82.8%,7.1%,99.3% VILI上述指标分别为：81.3%,84.6%,9.1%,99.6% HPV-DNA检测法上述指标为：87.5%,77.3%,6.8%,99.7%.结论 液基细胞学的诊断价值好于其余4种方法,可作为宫颈癌筛查的首选方法 肉眼观察由于其简单易行,价格低廉,可适用于经济欠发达地区的普通人群的筛查.

Objective To evaluate five screening methods of cervical cancer so as to popularize an effective screening strategy for cervical cancer in Zhejiang province. Methods A total of 1005 women aged 25 -65 years old were selected from Lishui where cervical cancer was highly prevalent. And 859 subjects were ultimately enrolled between June 2009 and December 2009. Each subject was subjected to five screening methods, including Pap smear, liquid-based cytology （LBC）, human papillomavirus DNA with a second-generation hybridization assay（ HC2 ）, visual inspection with acetic acid （VIA） and visual inspection with Lugol＇s iodine （VILI）. CIN （cervical intraepithelial neoplasia） 2 ＋ on biopsy was used as the reference standard for disease positivity. Negative colposcopy was accepted as a negative outcome. Results The sensitivity （Se）, specificity （Sp）, positive predictive value （PPV）, negative predictive value （NPV）were 25%, 90%, 26.7% and 98.6% for Pap smear 81.3%, 97.3%, 35. 1% and 99.6% for LBC 68.9%, 82. 8%, 7. 1% and 99. 3% for VIA 81.3%, 84. 6%, 9. 1% and 99.3% for VILI 87. 5%,77.3% and 6. 8% for HPV-DNA test respectively. Conclusions LBC is associated with a better profile of sensitivity, specificity and predictive value for five screening methods. It has the potential of optimizing the effectiveness of primary cervical cancer screening. Due to a low cost and an easy operation, VIA screening is an effective method of screening cervical cancer in the underdeveloped areas.