Validation of Cervical Cancer Screening Methods in HIV Positive Women from Johannesburg South Africa
Validation of Cervical Cancer Screening Methods in HIV Positive Women from Johannesburg South Africa
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DOI：
10.1371/journal.pone.0053494
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发表时间：
2013-01-11
期刊：
影响因子：
3.7
通讯作者：
Smith, Jennifer S.
中科院分区：
文献类型：
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作者：
Firnhaber, Cynthia;Mayisela, Nomtha;Smith, Jennifer S.
背景：感染艾滋病毒的女性患宫颈癌的风险增加。生活在资源有限国家的妇女由于难以获得宫颈癌筛查和治疗而面临特别高的风险。我们评估了三种宫颈癌筛查方法，以检测南非 HIV 感染女性中 2 级及以上宫颈上皮内瘤变 (CIN 2+)；巴氏涂片、5%醋酸（VIA）目视检查和人乳头瘤病毒检测（HPV）。方法：在约翰内斯堡招募18-65岁的HIV感染女性。进行了一项横断面研究，评估了三种检测组织学定义的金标准 CIN-2 + 的筛选方法。通过 Digene HC2 检测 (HPV)、子宫颈抹片检查和 VIA 对女性进行宫颈异常筛查。 VIA 由诊所护士进行，拍摄数码照片，然后由专科医生进行审查。使用最大似然估计器计算 CIN-2 + 的敏感性、特异性和预测值。结果：1,202 名 HIV 感染女性参与其中，中位年龄为 38 岁，CD4 计数为 394 个细胞/mm(3)。三分之一的女性在细胞学上有高度病变。 VIA 和 HPV 在女性中分别有 45% 和 61% 呈阳性。 HPV、巴氏涂片和 VIA 对 CIN 2+ 的估计敏感性/特异性分别为 92%/51.4%、75.8%/83.4% 和 65.4/68.5%（护士读数）。在 CD4 计数为 350 个细胞/mm(3) 的女性中，HPV 检测、细胞学和 VIA 的敏感性相似，特异性明显较低。结论：虽然 HPV 是检测 CIN 2+ 最敏感的筛查方法，但其特异性低于传统细胞学和数字成像检查的 VIA。筛选计划可能需要根据每个领域的资源和能力进行个性化。
Background: HIV-infected women are at increased risk for developing cervical cancer. Women living in resource-limited countries are especially at risk due to poor access to cervical cancer screening and treatment. We evaluated three cervical cancer screening methods to detect cervical intraepithelial neoplasia grade 2 and above (CIN 2+) in HIV-infected women in South Africa; Pap smear, visual inspection with 5% acetic acid (VIA) and human papillomavirus detection (HPV).Methods: HIV-infected women aged 18-65 were recruited in Johannesburg. A cross-sectional study evaluating three screening methods for the detection of the histologically-defined gold standard CIN-2 + was performed. Women were screened for cervical abnormalities with the Digene HC2 assay (HPV), Pap smear and VIA. VIA was performed by clinic nurses, digital photographs taken and then later reviewed by specialist physicians. The sensitivity, specificity and predictive valves for CIN-2 + were calculated using maximum likelihood estimators.Results: 1,202 HIV-infected women participated, with a median age of 38 years and CD4 counts of 394 cells/mm(3). One third of women had a high grade lesion on cytology. VIA and HPV were positive in 45% and 61% of women respectively. Estimated sensitivity/specificity for HPV, Pap smear and VIA for CIN 2+ was 92%/51.4%, 75.8%/83.4% and 65.4/68.5% (nurse reading), respectively. Sensitivities were similar, and specificities appeared significantly lower for the HPV test, cytology and VIA among women with CD4 counts 350 cells/mm(3).Conclusions: Although HPV was the most sensitive screening method for detecting CIN 2+, it was less specific than conventional cytology and VIA with digital imaging review. Screening programs may need to be individualized in context of the resources and capacity in each area.