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目的:评价醋酸染色肉眼观察(VIA)在宫颈癌筛查中分流自我取样人乳头瘤病毒(HPV)DNA阳性人群的可行性及应用价值。方法:对2 500名河南省新密市25～65岁的妇女进行宫颈癌筛查。初次访视时每位妇女均接受了自我取样HPV DNA检测和VIA。任何筛查阳性及随机10%阴性的妇女进行第2次VIA和阴道镜检查。阴道镜下可见病变处直接活检;无可见病变但筛查阳性时行四象限随机活检+宫颈管搔刮术(ECC)。以病理诊断为金标准。结果:最终有2 463名妇女纳入分析。目标人群自我取样HPV的阳性率为17.3%(427/2 463),检出CINⅡ+的灵敏度为89.2%(33/37),特异度为83.8%(2 032/2 426),阳性预测值(PPV)为7.7%(33/427)。用VIA对自我取样HPV DNA阳性者进行分流,阴道镜转诊率由17.3%(427/2 463)降至2.5%(61/2 463),χ2=304.7,P<0.001;特异度和PPV可分别达到98.3%(2 384/2 426)(χ2=350.0,P<0.001)和31.2%(19/61),χ2=30.7,P<0.001,灵敏度为51.4%。结论:用VIA分流自我取样HPV DNA阳性妇女,可以显著提高宫颈癌筛查的特异度和PPV值,明显降低阴道镜转诊率,对于未绝经妇女,意义更为显著。这种分流方法可以有效节约卫生资源,有望成为宫颈癌筛查分流的一种新选择。
Objective: To evaluate the feasibility and value of acetic acid staining for visual inspection (VIA) of shunt self-sampling human papillomavirus (HPV) DNA positive population in cervical cancer screening. Methods: Cervical cancer screening was conducted in 2 500 women aged 25-65 in Xinmi, Henan Province. Each woman underwent self-sampling for HPV DNA testing and VIA at the initial visit. The second VIA and colposcopy were performed on any women who tested positive and were randomly 10% negative. Colposcopy lesions can be seen directly biopsy; no visible lesions but positive screening four-quadrant random biopsy + cervical scraping (ECC). Pathological diagnosis as the gold standard. Results: A total of 2 463 women were included in the analysis. The positive rate of self-sampling HPV in the target population was 17.3% (427/2 463). The sensitivity and specificity of CINⅡ + were 89.2% (33/37) and 83.8% (2032/2 426) respectively. The positive predictive value PPV) was 7.7% (33/427). With VIA, self-sampling of HPV DNA positive patients were diverted, the colposcopy referral rate decreased from 17.3% (427/2 463) to 2.5% (61/2 463), χ2 = 304.7, P <0.001; specificity and PPV (2 384/2 426) (χ2 = 350.0, P <0.001) and 31.2% (19/61) respectively, χ2 = 30.7, P <0.001, with a sensitivity of 51.4%. Conclusion: VIA shunt self-sampling of HPV DNA-positive women can significantly improve the screening of cervical cancer specificity and PPV values, significantly reduce the colposcopy referral rate, for non-menopausal women, the significance is more significant. This shunt method can effectively save the health resources, is expected to become a new choice for cervical cancer screening shunt.