Visual inspection after acetic acid (VIA) is highly heterogeneous in primary cervical screening in Amazonian Peru.
Visual inspection after acetic acid (VIA) is highly heterogeneous in primary cervical screening in Amazonian Peru.
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乙酸后（VIA）后的视觉检查在亚马逊秘鲁的原发性宫颈筛查中是高度异质的。
DOI：
10.1371/journal.pone.0115355
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Sasieni P
中科院分区：
文献类型：
--
作者：
Almonte M;Ferreccio C;Luciani S;Gonzales M;Delgado JM;Santos C;Alvarez M;Cuzick J;Sasieni P
秘鲁目前在初级筛查中使用常规细胞学（巴氏涂片）和应用醋酸后目视检查（VIA）。研究表明，VIA的质量是高度可变的。在秘鲁亚马逊河流域开展的TATI项目中，对36 000多名妇女进行了巴氏和VIA筛查。在一项比较几种筛查技术（C-TATI）的巢式研究中，共有5435名妇女接受了液基细胞学（LBC）和高危人乳头瘤病毒检测（HR-HPV）的额外筛查。我们调查了C-TATI中VIA、Pap、LBC和HR-HPV阳性率的变化，以及TATI完全干预中VIA阳性率的变化。在筛查访视时，助产士在进行VIA之前收集了三份宫颈样本用于Pap，LBC和HC 2。分散因子“D”（D = Pearson卡方值/自由度）用于测量试验结果的变异性。在C-TATI中，还通过助产士和筛查月份的箱形图和散点图对VIA、Pap、LBC和HR-HPV阳性率的变异性进行了图形评估。漏斗图和平滑散点图被用来关联VIA的变化，由每个助产士在整个TATI干预进行检查的数量。与TATI一致，VIA结果是高度可变的，独立于检查者，进行测试的时间和检查者进行的测试次数（D>6，p值<0.001）。在C-TATI中，VIA结果变化最大，而HR-HPV的结果变化最小（VIA的Ds>25，p值<0.001，HR-HPV的Ds<1.6，p值>0.05）。没有证据表明每个助产士进行的VIA数量与VIA结果的变异性之间存在相关性。HR-HPV检测缺乏过度分散表明变量VIA结果不能反映潜在疾病的真实变化，而是人类判断缺乏一致性。
Conventional cytology (Pap) and visual inspection after the application of acetic acid (VIA) are currently used in primary screening in Peru. Studies suggest that the quality of VIA is highly variable. Over 36 000 women were screened with Pap and VIA in the TATI (Tamizaje y Tratamiento Inmediato de Lesiones Cervico-uterinas) project conducted in Amazonian Peru. Within a nested study to compare several screening techniques (C-TATI), a total of 5435 women were additionally screened with liquid-based cytology (LBC) and high-risk human papillomavirus testing (HR-HPV). We investigate the variation of positivity rates of VIA, Pap, LBC and HR-HPV in C-TATI and of VIA in the full TATI intervention. At the screening visit, midwives collected three cervical samples for Pap, LBC and HC2 before performing VIA. The dispersion factor “D” (D = Pearson chi-square value/degrees-of-freedom) was used to measure the variability of tests results. Within C-TATI, the variability of positivity rates of VIA, Pap, LBC and HR-HPV was also graphically assessed with box- and scatter plots by midwife and month of screening. Funnel plots and smoothed scatter plots were used to correlate the variation of VIA by the number of examinations performed by each midwife over the full TATI intervention. Consistently over TATI, VIA results were highly variable, independently of the examiner, the time when the test was performed and the number of tests the examiner performed (D>6, p-values<0.001). In C-TATI, VIA results varied the most while those of HR-HPV varied the least (Ds>25, p-values<0.001 for VIA, Ds<1.6, p-values>0.05 for HR-HPV). No evidence for correlation between the number of VIAs done per midwife and the variability of VIA results was observed. The lack of over-dispersion for HR-HPV detection suggests that the variable VIA results do not reflect true variation in underlying disease, but a lack of consistency in human judgement.
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DOI：
10.1016/j.bpobgyn.2011.08.003
发表时间：
2012-04-01
影响因子：
5.5
作者：
Sankaranarayanan, Rengaswamy;Nessa, Ashrafun;Dangou, Jean-Marie
通讯作者：
Dangou, Jean-Marie
DOI：
10.1097/igc.0b013e318280f395
发表时间：
2013-03-01
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DOI：
10.1016/j.ijgo.2010.01.019
发表时间：
2010-06-01
影响因子：
3.8
作者：
Murillo, Raul;Luna, Joaquin;Cendales, Ricardo
通讯作者：
Cendales, Ricardo
影响因子：
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Sankaranarayanan, R;Basu, P;Parkin, DM
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Parkin, DM
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Belinson, J;Qiao, YL;Zahniser, D
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Zahniser, D