醋酸碘染色法联合阴道镜对非洲马里女性宫颈癌的筛查效果

郑国强　唐咏梅　王乐见

[摘要] 目的 評价醋酸/碘染色法（VIA/VILI）联合阴道镜对非洲马里女性宫颈癌及其癌前病变的筛查效果。 方法 选取2015年8月至2018年8月3657例符合条件的非洲马里女性，采用VIA/VILI和阴道镜下病理活检筛查技术开展宫颈癌筛查，评价该技术的初筛效果和宫颈上皮瘤变中度（CIN2）+病变检出效果。 结果 每个年龄段女性对宫颈癌筛查的积极率不同，随着年龄的增加，其积极率也随之降低;VIA/VILI和病理活检的调整CIN2+病变检出率分别为1.89%、2.16%;VIA/VILI的筛查阳性率随着年龄增长下降较为平缓，而阴道镜下病理活检结果筛查阳性率随着年龄的增长逐渐增长;敏感度、特异度、阳性预测值、阴性预测值、准确性及约登指数分别为84.81%、85.35%、11.34%、99.61%、85.34%及0.70%;筛查人群的首次性交平均年龄为（17.78±2.93）岁，一夫多妻占54.50%，既往宫颈筛查占3.91%，女性行割礼术占90.37%，该人群中小学及以下文化程度的女性占70.19%。 结论 应用VIA/VILI筛查宫颈癌前病变有较高敏感度、特异性，但在应用和推广中存在一定的局限性、主观性，应予以重视。

[关键词] 非洲马里;VIA/VILI;阴道镜;病理活检

[中图分类号] R446          [文献标识码] B          [文章编号] 1673-9701（2021）04-0122-04

Screening effect of iodine acetate staining combined with colposcopy on cervical cancer in African Mali women

ZHENG Guoqiang1   TANG Yongmei1   WANG Lejian2

1.Department of Pathology， Yiwu Central Hospital in Zhejiang Province， Yiwu   322000， China; 2.Department of Laboratory，Taizhou Central Hospital in Zhejiang Province， Taizhou   318000， China

[Abstract] Objective To evaluate the screening effect of acetic acid/iodine staining（VIA/VILI） combined with colposcopy on cervical cancer and precancerous lesions in African Mali women. Methods A total of 3657 eligible African Malian women from August 2015 to August 2018 were selected. The VIA/VILI and colposcopy pathological biopsy screening technology was used to conduct cervical cancer screening. The initial screening effect and detection effect  of  moderate neoplasia（CIN2）+ lesion of  cervical intraepithelial neoplasia by this technology were evaluated. Results The positive rate of cervical cancer screening varies among women of each age group. As the age increased， the positive rate decreased. The adjusted CIN2+ lesion detection rate by VIA/VILI and pathological biopsy was 1.89% and 2.16%， respectively. The positive rate of screening  by VIA/VILI decreased gradually with age， and the positive rate of pathological biopsy results under colposcopy gradually increased with age. The sensitivity， specificity， positive predictive value， negative predictive value， accuracy and Yoden indexes were 84.81%， 85.35%， 11.34%， 99.61%， 85.34% and 0.70%. The average age of first sexual intercourse in the screened population was（17.78±2.93） years， with polygamy accounting for 54.50%， previous cervical screening 3.91%， and female circumcision 90.37%. 70.19% of the females had primary and secondary schools. Conclusion The application of VIA/VILI for screening cervical precancerous lesions has high sensitivity and specificity， but there are certain limitations and subjectivity in the application and promotion， which should be paid attention to.

[Key words] African Mali;VIA/VILI; Colposcopy; Pathological biopsy

宫颈癌是女性常见恶性肿瘤之一，居女性恶性肿瘤的第二位[1]。全球癌症数据库（GLOBOCAN2018）显示非洲的宫颈病变新发病例和死亡案例达10.55万例和6.93万例，占全球新发病例和死亡案例的比例为5.8%和7.3%。细胞学筛查策略的实施改善了发达国家对宫颈癌的控制[2]，在资源贫乏国家复制细胞学筛查策略受到成本限制[3]。2000年国际癌症研究机构启动非洲“替代方法（VIA和VILI）”，有报道VIA/VILI观察存在较多的主观性，不同研究中报道的VIA/VILI敏感性和特异度相差较大。……