2006—2009年山西省襄垣县VIA/VILI筛查宫颈癌的检出效果评价

Clinical evaluation of the performance of VIA/VILI for cervical cancer screening during 2006-2009 in Xiangyuan county,Shanxi province

目的：通过对2006—2009年山西省襄垣县宫颈癌筛查早诊早治结果分析，评价醋酸或碘染色肉眼观察法（visual inspection with acetic acid/Lugol’s iodine，VIA/VILI）宫颈癌筛查方案在农村高发区推广应用的可行性。方法2006—2009年在山西省襄垣县对30-59岁的妇女进行宫颈癌筛查。用VIA和VILI作为初筛方法，VIA/VILI阳性者进行阴道镜检查，阴道镜异常者在病变处取活检进行病理诊断。对VIA和VILI阴性、VIA/VILI阳性但阴道镜检查正常、VIA/VILI阳性同时阴道镜检查异常且病理活检结果为轻度宫颈上皮内瘤样病变（cervical intraepithelial neoplasia grade 1，CIN1）或正常的妇女一年后用与初筛同样的方法进行复查。结果2006—2010年累计筛查16703人次，其中初筛9618人，复查7085人。4年初筛人群累计阴道镜转诊率、中度CIN及以上（CIN2＋）检出率、重度CIN及以上（CIN3＋）检出率分别为4.6%（438/9618）、0.9%（82/9618）、0.5%（44/9618）；复查人群上述指标分别为3.1%（221/7085）、0.6%（42/7085）、0.2%（19/7085）；筛查人群累计（包括初筛和复查）上述指标分别为4.0%（659/16703）、1.3%（124/9618）、0.7%（63/9618）。初筛人群阴道镜转诊率、CIN2＋检出率和CIN3＋检出率均随方案的持续开展呈升高趋势（P〈0.001）；复查阴道镜转诊率、CIN2＋检出率则呈下降趋势（P〈0.001）。结论随着VIA/VILI筛查方案在示范基地的推广，筛查效果越来越显著。VIA/VI-LI是一种经济有效的宫颈癌及其癌前病变筛查方法，适宜在资源有限、经济欠发达的农村地区推广。持续的培训和实践是VIA/VILI筛查方案有效实施的关键措施。

Objective To evaluate the feasibility of popularization and application of visual inspection with acetic acid/Lugol ’s iodine （VIA/VILI） program for cervical cancer screening in rural areas through analyzing the perfor-mance of cervical cancer screening in Xiangyuan County, Shanxi Province during 2006-2009. Method Women aged 30-59 years from Xiangyuan County in Shanxi Province were recruited for cervical cancer population-based screening from 2006 to 2009. VIA/VILI was used as the primary screening method followed by colposcopy if the VIA/VILI re-sult was positive, and direct biopsies were taken if the colposcopy results were abnormal. Women with negative VIA/VILI, with positive VIA/VILI but normal colposcopy, or with positive VIA/VILI, yet abnormal pathological biopsy re-sults, and normal cervical intraepithelial or cervical intraepithelial neoplasia grade 1 （CIN1） were scheduled to repeat-ed the same screening procedure in the next year. Result A total of 16 703 screening were performed between 2006-2010, including 9618 in the 1st round and 7085 in the 2nd round. The 4-year accumulative colposcopy referral rate, positive rate of moderate CIN and above, and positive rate of severe CIN and above （CIN3＋） were 4.6% （438/9618）, 0.9% （82/9618） and 0.5% （44/9618） in the 1st round screening, respectively, and were 3.1% （221/7085）, 0.6%（42/7085） and 0.2% （19/7085） in the 2nd round screening, respectively, while the results were 4.0% （659/16 703）, 1.3% （124/9618） and 0.7% （63/9618） as the two round screening combined, respectively. With the continuous imple-mentation of the program, the colposcopy referral rate and the positive rates of CIN2＋ and CIN3＋ tended to increase in the 1st round screening （P〈0.001）; but the colposcopy referral rate and the positive rate of CIN2＋ showed a down-trend in the 2nd round screening （P〈0.001）. Conclusion With the popularization of the VIA/VILI-based screening program in rural pilot sites, the performance of the program became more and more significant. It is perceived that VIA/VILI may be appropriately applied as a cost-effective cervical cancer screening procedure in rural areas with lim-ited resources and lower income. Continuous training and practice is the key to ensuring the effective implementation of VIA/VILI-based screening.