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,...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 significantlyreduce 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 careH PV?, 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.展开更多
目的通过诊断试验Meta分析，评价在中国女性中使用醋酸染色肉眼观察法（VIA）对宫颈癌及其癌前病变进行初筛的效果。方法以“醋酸”、“宫颈上皮内瘤样病变”、“宫颈癌”、“visual inspection with acetic acid”、“CIN”和“cervica...目的通过诊断试验Meta分析，评价在中国女性中使用醋酸染色肉眼观察法（VIA）对宫颈癌及其癌前病变进行初筛的效果。方法以“醋酸”、“宫颈上皮内瘤样病变”、“宫颈癌”、“visual inspection with acetic acid”、“CIN”和“cervical cancer”作为检索词分别检索万方数据库、中国知网（CNKI）、维普中文科技期刊全文数据库、Pubmed、Cochrane图书馆等，并对所获文献中的参考文献进行二次检索，收集关于在中国妇女中开展VIA初筛宫颈癌及其癌前病变的相关文献，共检索到相关文献40篇。采用SAS8．02进行双变量随机效应模型进行统计学分析。结果最终有22篇文献符合纳入标准，包括中文文献19篇，英文文献3篇，纳入研究对象共计23330名。入选文献年限跨度为2004-2010年，研究对象年龄范围为15—81岁。按不同筛查病变阈值分层后可见，VIA初筛轻度及以上宫颈上皮内瘤样病变（CIN1＋）的加权诊断比值比（DOR）[4．11（95％C／：3．20～5．04）]与中度及以上病变（CIN2＋）[4．45（95％CI：3．73～5．15）]相近。CIN1＋和CIN2＋在40岁及以下中国女性中VIA的DOR[CIN1＋为4．22（95％CI：3．29～5．16）；CIN2＋为4．53（95％CI：3．46～5．47）]也均与40岁以上女性相近[CIN1＋为3．66（95％CI：2．27～5．37）；CIN2＋为4．26（95％C／：3．32～5．26）]。对于CIN2＋，县级医院筛查效果与市级及以上医院无区别，DOR分别为4．62（95％CI：3．13～5．93）和4．48（95％CI：3．71—5．16）。结论VIA对于各级病变和各年龄段人群筛查效果较为一致，县级医院的医生经培训后能够达到与市级医院一样的水平。展开更多
基金Supported by fellowships from the Prime Minister of AustraliaAsia Endeavour Award,Ministry of Higher Education,Malaysiaand University Technologi MARA,Malaysia
文摘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 significantlyreduce 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 careH PV?, 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.
