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VIA、VILI+巴氏涂片在宫颈病变筛查中的应用价值
目的:分析简单易行的VIA/VILI结合传统的巴氏涂片对宫颈病变筛查的价值.方法:2004年6月～2008年3月对462例非子宫恶性肿瘤、欲行包括子宫全切的手术前病人,采用巴氏涂片加VIA、VILI例行宫颈检查.终宫颈诊断以当即进行的活检或手术后病理结果为标准.结果:在462例患者中检出CIN1 13例(阴道镜下活检病理);CIN2 8例(道镜下活检病理6例,术后病理2例);CIN3 1例(阴道镜下活检病理);CIN3合并早期浸润腺癌1例.总病变率4.97%.采用VIA及VILI观察阳性32例(6.92%),巴氏涂片的阳性率为5.4%(25例),敏感性95.7%(22/23),特异性94.1%(434/462).VIA/VILI结合巴氏涂片法均阳性的病例22例,其中病理证实的低度病变22例,高度病变2例;假阳性率为1例,假阴性0例.敏感性(24/23)100%,特异性94.6%.结论:VIA/VILI和巴氏涂片结合的方法,不仅适合医疗资源匮乏,难以推广复杂、昂贵的经济落后地区的宫颈病变筛查,而且可以推广到各级层妇科门诊的机会性筛查.
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两种方法筛查子宫颈癌的效果分析
目的 对比分析两种方法检出宫颈疾病的差异,为进一步制定宫颈癌的筛查策略提供依据.方法 按整群抽样的方法,对2014年新密市35～64岁的农村妇女分两组进行宫颈癌筛查:一组采用VIA/VILI结合巴氏涂片的方法(绝经前妇女使用VIA/VILI筛查,绝经后妇女使用巴氏涂片);另一组妇女采用高危型HPV检测法筛查.VIA/VILI异常、巴氏涂片结果≥不明确意义的非典型鳞状细胞(ASC-US)及HPV阳性者转诊阴道镜,并对镜下异常处取活检,活检结果CIN2及以上病变的妇女需手术治疗.结果 VIA/VILI结合巴氏涂片筛查6 694例妇女,平均年龄(48.71±8.25)岁,阳性率17.28％,CIN Ⅰ、CINⅡ、CINⅢ及宫颈癌的检出率分别是0.19％、0.16％、0.13％、0.03％.高危型HPV筛查妇女18 345例,平均年龄(47.58±8.39)岁,阳性率10.80％,50岁以上妇女的阳性率较高;CIN Ⅰ、CINⅡ、CINⅢ及宫颈癌的检出率分别是0.56％、0.31％、0.39％、0.08％.与VIA/VILI结合巴氏涂片法比较,高危型HPV对宫颈癌前病变的检出率高(P＜0.01).结论 2014年新密市宫颈癌前病变及宫颈癌检出率较高;HPV筛查能够提高宫颈癌前病变的检出率,基层单位有能力独立完成筛查,应作为宫颈癌筛查方法推广使用.
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江西铜鼓子宫颈癌筛查与生殖道健康现状的初步分析
目的:分析铜鼓县妇女生殖道感染现状与子宫颈癌及其癌前病变检出率,为促进子宫颈癌筛查和妇女生殖道健康保健提供依据.方法:2008～2009年共有30～59岁的妇女4 010例入选为合格的研究对象,进行流行病学问卷后,以VIA/VILI为子宫颈癌初筛方法,同时检查生殖道感染和白带常规.用SPSS 16.0软件对数据进行统计学分析.结果:此人群中35～49岁妇女生殖道疾病检出率较高,占68.5%(2 736/3 992),其中生殖道感染检出率为44.5%(1775/3 992);VIA+VILI初筛阳性率为12.3%(493/4 010),经病理确诊的子宫颈癌与癌前病变检出率为723.2/10万,95.O%(38/40)为子宫颈癌前病变.结论:30～59岁的妇女有47.3%患有生殖道疾病,其中35～49岁的妇女所占比例大,是预防控制的主要对象;VIA+VILI初筛可筛选出大部分癌前病变.VIA+VILI初筛联合生殖道检查能有效地控制子宫颈癌及其生殖系统疾病.
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非洲马里女性宫颈癌前病变联合筛查的调查分析
目的 筛查西非马里女性宫颈癌前病变的流行病学特征,为制定相应的干预措施提供依据.方法 筛查对象来自西非马里2015年1月-2017年11月年龄为(39.85 ±14.21)岁女性1 830例,进行妇科常规检查、醋酸肉眼观察(VIA)、碘液染色肉眼观察法(VILI)、宫颈细胞学、阴道镜检查及组织病理学筛查.结果 1 830例VIA/VILI检测的敏感度为87.67％ (128/146),特异度为71.38％(1 202/1 684);610例细胞学宫颈癌前病变阳性检出率为20.98％,其中首次性交年龄为15岁～ 20岁患者的发生癌前病变阳性检出率为10.49％;年龄为40岁～50岁的癌前病变阳性检出率为6.39％;125例女性组织学宫颈癌前病变阳性检出率为76.19％,CINⅡ及以上级别病变阳性检出率为55.56％.结论 通过本次对子宫颈癌前病变的调查发现导致宫颈病变高发与一夫多妻、首次性交年龄、医疗卫生等因素有关.
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Comparative Study of careHPV Assay,Visual Inspection and Pap Smears as Primary Screening in Rural China
To compare the performance of visual inspection with acetic acid and with Lugol's iodine (VIA/VILI), cytology and careHPV DNA assay in rural China performed by local health providers. Eligible women living in rural areas in Xinmi County, Henan Province were invited to participate in cervical cancer screening program. Enrolled women were randomized into 3 intervention arms, screened by VIA/VILI, pap smears, and careHPV assay respectively. Women had positive primary screening results were referred to colposcopy and/or biopsy.All the clinical and lab work was performed by local health providers. The final diagnoses of histopathology were based on the diagnosing of a senior histopathology expert from Cancer Hospital, Chinese Academy of Medical Sciences. Questionnaires about the knowledge and attitudes towards the HPV and the screening program of the health providers at village clinics were collected. Finally, 894 women had careHPV DNA test, 552 underwent VIA/ VILI and 547 had Pap smears. The positive rates for careHPV assay, VIA/VILI and Pap smears were 10. 6％, 18. 1％, and 4. 9％ respectively (χ2 = 48. 647, P < 0.001). The overall CIN2 + detection rate was 0. 5％, the CIN2 + detection rate for the three arms were not significantly different even that of careHPV was higher than the other arms (0. 7％ for careHPV assay, 0. 5％ for VIA/ VILI, 0. 2％ for pap smear, χ2 = 1. 648, P = 0. 439). The knowledge of the health providers about HPV, HPV assay in screening was unsatisfactory. However, their attitudes about implementing HPV assay into the national program were positive. Implementing careHPV assay in low resource settings and performed by simply trained lab personnel is possible. Education for implementing HPV assay in local health providers is needed.
