巴氏涂片检查和目视检查进行宫颈筛查，以在资源匮乏、高危社区实现当日活检。

Cervical Screening by Pap Test and Visual Inspection Enabling Same-Day Biopsy in Low-Resource, High-Risk Communities.

机构信息

Departments of Pathology and Obstetrics and Gynecology, the First Affiliated Hospital, Shihezi University School of Medicine, the Key Laboratories for Xinjiang Endemic and Ethnic Diseases and the Department of Public Health, Shihezi University, and the Department of Histology and Embryology, School of Medicine, Shihezi University, Shihezi, Xinjiang, the Department of Pharmacology, Kashi Prefecture First People's Hospital, and the Department of Surgery, Kashi Prefecture Second People's Hospital, Kashi Prefecture Health Bureau, Kashi Prefecture, Xinjiang, the Department of Pathology, Chaoyang Hospital, the Capital Medical University, Beijing, and the Department of Epidemiology and Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; and the Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia.

出版信息

Obstet Gynecol. 2018 Dec;132(6):1421-1429. doi: 10.1097/AOG.0000000000002973.

DOI:10.1097/AOG.0000000000002973

PMID:30399093

Abstract

OBJECTIVE

To develop an effective, low-cost, single-visit cervical screening strategy incorporating a modified Pap test and visual inspection with acetic acid and Lugol's iodine for low-income settings.

METHODS

We conducted a prospective cohort trial. Two low-income Muslim Uyghur communities in China's far western Kashi Prefecture served as pilot and validation study sites, respectively, and 4,049 women (aged 30-59 years) were screened. The conventional Pap test was modified using a cotton swab to collect cervical cells without scraping the cervix using an Ayre spatula, allowing visual inspection with acetic acid (and visual inspection with Lugol's iodine if visual inspection with acetic acid was negative) to be performed in a single visit. Results from both tests were available within 1-2 hours. Women positive for either or both underwent same-day biopsy that was shipped by a courier service to a central pathology laboratory.

RESULTS

Single-visit screening incorporating both a modified Pap test and visual inspection achieved a sensitivity of 96.0% (95% CI 91.6-100), which was superior to Pap testing (76%, 95% CI 66.3-85.7; P<.001) or visual inspection with acetic acid-visual inspection with Lugol's iodine (48%, 95% CI 36.7-59.3; P<.001) alone in detecting cervical intraepithelial neoplasia (CIN) 2 or worse lesions. Rapid interpretation of both diagnostic procedures facilitated efficient same-day biopsy that achieved a negative predictive value of 98.2% in detecting CIN 2 or worse lesions. The increased sensitivity and minimized loss of follow-up allowed this approach to identify an extremely high prevalence of CIN 1 (2,741/100,000, 95% CI 2,238-3,245/100,000), CIN 2 or 3 (1,457/100,000, 95% CI 1,088-1,826/100,000), and cervical cancer (395/100,000, 95% CI 202-589/100,000) among these underscreened, at-risk women.

CONCLUSION

Single-visit cervical screening with both a modified Pap test and visual inspection has greater sensitivity to detect high-grade CINs, reduces loss of follow-up, and could be an efficient low-cost strategy for low-resource settings.

摘要

目的

开发一种有效、低成本、单次就诊的宫颈筛查策略，结合改良巴氏涂片检查、醋酸和卢戈碘液的目视检查，适用于低收入环境。

方法

我们进行了一项前瞻性队列研究。中国西部喀什地区的两个低收入穆斯林维吾尔族社区分别作为试点和验证研究地点，共筛查了 4049 名 30-59 岁的妇女。改良巴氏涂片检查采用棉签采集宫颈细胞，而不是用 Ayre 刮板刮取宫颈细胞，允许在单次就诊时进行醋酸目视检查（如果醋酸目视检查阴性，则进行卢戈碘液目视检查）。两种检查的结果在 1-2 小时内均可获得。两种检查均为阳性或任意一种检查为阳性的妇女，当天接受活检，通过快递服务将活检标本送往中央病理实验室。

结果

单次就诊筛查结合改良巴氏涂片检查和醋酸、卢戈碘液目视检查的敏感性为 96.0%（95%CI 91.6-100），优于巴氏涂片检查（76%，95%CI 66.3-85.7；P<.001）或单独醋酸目视检查-卢戈碘液目视检查（48%，95%CI 36.7-59.3；P<.001），可检测出宫颈上皮内瘤变（CIN）2 及更高级别病变。快速解读两种诊断程序有助于进行高效的当天活检，在检测出 CIN 2 及更高级别病变时，其阴性预测值为 98.2%。敏感性的提高和随访损失的最小化使得这种方法能够发现极高比例的 CIN 1（2741/100000，95%CI 2238-3245/100000）、CIN 2 或 3（1457/100000，95%CI 1088-1826/100000）和宫颈癌（395/100000，95%CI 202-589/100000）。这些妇女是筛查不足的高危人群。