Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa
Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa
复制标题
DOI：
10.1002/ijc.20190
复制
发表时间：
2004-07-20
影响因子：
6.4
通讯作者：
Parkin, DM
中科院分区：
文献类型：
--
作者：
Sankaranarayanan, R;Basu, P;Parkin, DM
基于目视检查的筛查测试，例如使用4%乙酸（VIA）和卢戈碘（VILI）的目视检查，已被提议作为大规模筛查计划中细胞学的替代方法。迄今为止，只有有限的信息，这些测试在检测高级别鳞状上皮内病变（HSIL）的准确性。在布基纳法索、刚果、几内亚、印度、马里和尼日尔进行了11项横断面研究，涉及56,939名25-65岁的妇女，以评估卫生工作者进行的VIA和VILI的准确性。使用了共同的方案和问卷。为了最终诊断，所有女性都接受了阴道镜检查，并在必要时进行活检。汇总研究数据，计算HSIL检测的敏感性、特异性和预测值。在接受筛查的妇女中，分别有16.1%和16.4%的妇女在使用VIA和VILI进行检查时呈阳性; 1,063人呈阳性。诊断为HSIL。VIA的合并敏感性、特异性、阳性和阴性预测值分别为76.8%（95% CI：74.2-79.4%）、85.5%（95% CI：85.2-85.8%）、9.4%（95% CI：8.8-10.8%）和99.5%（95% CI：99.4-99.6%）。VILI的数值分别为91.7%（95% CI：89.7-93.4%）、85.4%（95% CI：85.1-85.7%）、10.9%（95% CI：10.2-11.6%）和99.8%（95% CI：99.7-99.9%）。VIA的敏感性和特异性范围分别为56.1-93.9%和74.2- 93.8%，VILI的敏感性和特异性范围分别为76.0-97.0%和73.0-91.3%。VILI检测HSIL的敏感性显著高于VIA，但特异性相似。VILI似乎是一种更准确的视力测试，可用于低资源环境中的筛查和治疗计划。(C)2004威利-利斯公司
Visual inspection-based screening tests, such as visual inspection with 4% acetic acid (VIA) and with Lugol's iodine (VILI), have been proposed as alternatives to cytology in mass screening programs. To date, there is only limited information on the accuracy of these tests in detecting High-grade Squamous Intraepithelial Lesions (HSIL). Eleven cross-sectional studies involving 56,939 women aged 25-65 years were conducted in Burkina Faso, Congo, Guinea, India, Mali and Niger to evaluate the accuracy of VIA and VILI performed by health workers. A common protocol and questionnaire was used. For final diagnosis, all women were investigated with colposcopy and biopsies were taken when necessary. Data from the studies were pooled to calculate sensitivity, specificity and predictive values of the tests for the detection of HSIL. Of the screened women, 16.1% and 16.4% were positive on examination using, respectively, VIA and VILI; 1,063 were! diagnosed with HSIL. The pooled sensitivity, specificity, positive and negative predictive values for VIA were 76.8% (95% CI: 74.2-79.4%), 85.5% (95% CI: 85.2-85.8%), 9.4% (95% CI:8.8-10.8%) and 99.5% (95% CI:99.4-99.6%), respectively. The values were 91.7% (95% CI:89.7-93.4%), 85.4% (95% CI:85.1-85.7%), 10.9% (95% CI:10.2-11.6%) and 99.8% (95% CI:99.7-99.9%), respectively for VILI. The range of sensitivity and specificity for VIA was 56.1-93.9% and 74.2-93.8%, respectively, between studies and were 76.0-97.0% and 73.0-91.3% for VILI. VILI had a significantly higher sensitivity than VIA in detecting HSIL, but specificity was similar. VILI appears to be a more accurate visual test for use in screening and treatment programs in low-resource settings. (C) 2004 Wiley-Liss, Inc.