Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen-positive women: results from the ESTAMPA study.
Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen-positive women: results from the ESTAMPA study.
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DOI：
10.1002/ijc.34384
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发表时间：
2023-04-15
影响因子：
6.4
通讯作者：
Almonte, Maribel
中科院分区：
文献类型：
--
作者：
Baena, Armando;Mesher, David;Salgado, Yuli;Martinez, Sandra;Villalba, Griselda Raquel;Amarilla, Maria Luisa;Salgado, Brenda;Flores, Bettsy;Bellido-Fuentes, Yenny;Alvarez-Larraondo, Manuel;Valls, Joan;Lora, Oscar;Virreira-Prout, Gonzalo;Figueroa, Jacqueline;Turcios, Elmer;Soilan, Ana Maria;Ortega, Marina;Celis, Marcela;Gonzalez, Mauricio;Venegas, Gino;Teran, Carolina;Ferrera, Annabelle;Mendoza, Laura;Kasamatsu, Elena;Murillo, Raul;Wiesner, Carolina;Broutet, Nathalie;Luciani, Silvana;Herrero, Rolando;Almonte, Maribel
关键词：
VIA推荐用于对参加宫颈筛查的HPV阳性女性进行分诊。在多中心ESTAMPA研究中，评估了VIA在HPV阳性女性中检测宫颈上皮内瘤变3级或更严重（CIN 3+）的性能。年龄在30 - 64岁的女性接受HPV检测和细胞学筛查，如果任一检测结果为阳性，则接受阴道镜检查。在阴道镜检查访视时，经过研究培训的助产士/护士/全科医生在阴道镜检查前进行了VIA。如果在转化区或其附近观察到醋酸白病变，则认为VIA为阳性。评估VIA阳性患者的消融治疗资格。对业绩指标进行了估计。3142名HPV阳性女性被纳入。在50岁以下的女性中，CIN 3+的敏感性为85.9%（95% CI 81.2 - 89.5），尽管不显著，但在50岁以上的女性中略低（78.0%，95% CI 65.9 - 86.6）。总体特异性为58.6%（95%CI 56.7 - 60.5），50岁以上女性（70.3%，95%CI 66.8 - 73.5）的特异性显着高于<50岁女性（54.3%，95%CI 52.1 - 56.5）。50岁以上女性的VIA阳性率（35.2%，95% CI 31.9 - 38.6）低于50岁以下女性（53.2，95% CI 51.1 - 55.2）。消融治疗的总体合格率为74.5%，年龄无差异。VIA灵敏度、特异性和阳性以及消融治疗合格性因提供者而异（范围分别为：25%-95.4%、44.9%-94.4%、8.2%-65.3%、0%-98.7%）。VIA对HPV阳性妇女宫颈癌前病变检测的敏感性较高，转诊率显著降低。然而，由于VIA性能的高度可变性以及提供者对培训和监督的需求，VIA分流的HPV筛查规模扩大将具有挑战性。 有什么新消息吗？ 世卫组织的宫颈癌筛查指南包括部分HPV基因分型、细胞学检查、醋酸目视检查（VIA）和阴道镜检查，以对HPV阳性女性进行分诊。在这里，作者报告了VIA对HPV阳性女性进行分流的性能。来自拉丁美洲5个研究中心的数据显示，VIA在HPV阳性女性中检测到约85%的高级别宫颈病变，特别是50岁以下的女性。该方法还正确识别了近60%的无病变女性，减少了近50%的HPV阳性女性的转诊或治疗。然而，根据考官的技巧，表现会有所不同。
VIA is recommended for triage of HPV‐positive women attending cervical screening. In the multicentric ESTAMPA study, VIA performance for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among HPV‐positive women was evaluated. Women aged 30‐64 years were screened with HPV testing and cytology and referred to colposcopy if either test was positive. At colposcopy visit, study‐trained midwives/nurses/GPs performed VIA ahead of colposcopy. VIA was considered positive if acetowhite lesions were observed in or close to the transformation zone. Ablative treatment eligibility was assessed for VIA positives. Performance indicators were estimated. Three thousand one hundred and forty‐two HPV‐positive women were included. Sensitivity for CIN3+ was 85.9% (95% CI 81.2‐89.5) among women <50 years and, although not significant, slightly lower in women 50+ (78.0%, 95% CI 65.9‐86.6). Overall specificity was 58.6% (95% CI 56.7‐60.5) and was significantly higher among women 50+ (70.3%, 95% CI 66.8‐73.5) compared to women <50 (54.3%, 95% CI 52.1‐56.5). VIA positivity was lower among women 50+ (35.2%, 95% CI 31.9‐38.6) compared to women <50 (53.2, 95% CI 51.1‐55.2). Overall eligibility for ablative treatment was 74.5% and did not differ by age. VIA sensitivity, specificity, and positivity, and ablative treatment eligibility varied highly by provider (ranges: 25%‐95.4%, 44.9%‐94.4%, 8.2%‐65.3%, 0%‐98.7%, respectively). VIA sensitivity for cervical precancer detection among HPV‐positive women performed by trained providers was high with an important reduction in referral rates. However, scaling‐up HPV screening triaged by VIA will be challenging due to the high variability of VIA performance and providers' need for training and supervision. What's new? WHO guidelines for cervical cancer screening include partial HPV genotyping, cytology, visual inspection with acetic acid (VIA), and colposcopy to triage HPV‐positive women. Here, the authors report on the performance of VIA to triage HPV‐positive women. Data from 5 sites across Latin America showed that VIA detected about 85% of high‐grade cervical lesions in HPV‐positive women, particularly those under age 50. The method also correctly identified almost 60% of women without lesions, reducing referral or treatment to nearly 50% of HPV‐positive women. However, the performance varied depending on the skill of the examiner.
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影响因子：
3.7
作者：
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