Screening for cervical neoplasia in a developing country utilizing cytology, cervicography and the acetic acid test
Screening for cervical neoplasia in a developing country utilizing cytology, cervicography and the acetic acid test
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DOI：
10.1016/s0020-7292(00)00382-9
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发表时间：
2001-02-01
影响因子：
3.8
通讯作者：
Divall, PDJ
中科院分区：
文献类型：
--
作者：
Cronjé, HS;Cooreman, BF;Divall, PDJ
目的：比较宫颈癌前病变的三种筛查方法。方法：对6301例妇女同时进行宫颈细胞学、宫颈造影和醋酸试验（AAT）筛查。从醋酸白病变和每五个看似正常的宫颈进行活检。阳性病例（筛选和组织学检查时）转诊进行阴道镜检查。组织学结果作为金标准。结果：宫颈细胞学阳性率为1.7%，宫颈造影阳性率为10.7%，AAT阳性率为17.8%。宫颈细胞学检查的敏感性为19.3%，宫颈造影为41.8%，AAT为49.4%。特异性分别为99.3%、78.8%和48.5%。在23%的活检显示宫颈上皮内瘤变（I-III级），所有三个筛选试验均为阴性。通过结合三种测试，实现了76.9%的灵敏度。结论：在发展中国家，细胞学检查的敏感性不足以作为筛查试验，因为那里的筛查方案往往不足。筛查与测试的组合，一次或几次，每个女人的生活，是一个更可接受的替代方案，因为它允许较少的筛选事件，而不会降低敏感性。(C)2001年国际妇产科联合会。All rights reserved.
Objective: To compare three screening tests for cervical neoplasia. Method: Women (6301) were screened simultaneously with cytology, cervicography and the acetic acid test (AAT). Biopsies were taken from the acetowhite lesions and every fifth seemingly normal cervix. Positive cases (both at screening and histology) were referred for colposcopy. The histology results served as the golden standard. Results: Cytology was positive in 1.7% of cases, cervicography in 10.7% and the AAT in 17.8%. The sensitivity of cytology was 19.3%, of cervicography 41.8% and the AAT 49.4%. Corresponding specificities were 99.3%, 78.8% and 48.5%. In 23% of biopsies showing cervical intraepithelial neoplasia (grade I-III), all three screening tests were negative. By combining the three tests, a sensitivity of 76.9% was achieved. Conclusion: The sensitivity of cytology alone is not great enough for implementing as a screening test in a developing country where screening programs are often inadequate. Screening with a combination of tests, once or a few times per woman's life, is a more acceptable alternative since it allows for less screening events without sacrifying sensitivity. (C) 2001 International Federation of Gynecology and Obstetrics. All rights reserved.