醋酸目视检查作为宫颈癌的筛查试验

Srabani Mittal, J. Biswas, P. Basu
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引用次数: 2

摘要

在资源有限的情况下,醋酸目视检查(VIA)已被广泛研究并被接受为细胞学或人乳头瘤病毒(HPV)筛查的潜在替代方法。在发展中国家,VIA可能比细胞学或HPV筛查有几个优势。该测试的耗材成本低且容易获得。由于该检测可由广泛的训练有素的卫生保健人员进行,并且需要基本的卫生基础设施,因此具有实现大规模人口覆盖的潜力。这是一种实时检测,提供了在同一次就诊期间为筛查阳性妇女提供治疗的后勤优势,从而提高了治疗覆盖率。VIA的敏感性和特异性估计通常落在细胞学和HPV检测报告的范围内。评估VIA测试性能的随机对照试验表明,在研究人群中,宫颈癌发病率和死亡率有所降低。VIA的主要限制是它是一种主观测试,准确性取决于训练有素的提供者的技能。低特异性和次优阳性预测值导致不必要的转诊和/或治疗,这可以抵消该测试的低成本。基于VIA的筛选项目需要有明确定义的可衡量指标和框架来确定项目的优势和劣势。VIA的质量保证是具有挑战性的,特别是因为在多提供商的实际编程设置中,有关测试性能的信息有限。高质量的培训、定期进修课程、受过培训的提供者的专业知识和密切监测绩效指标是确保高质量VIA的必要条件。
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Visual inspection with acetic acid as a screening test for cervical cancer
Visual inspection with acetic acid (VIA) has been extensively investigated and accepted as potential alternative to cytology or Human Papilloma Virus (HPV) screening in limited resource settings. In developing countries, VIA may have several advantages over cytology or HPV screening. The consumables of the test are low-cost and readily available. VIA has potential of achieving large population coverage, as the test can be performed by a wide range of trained health care personnel and requires basic health infrastructure. It is a real-time test and offers logistic advantage of providing treatment for screen positive women during the same visit leading to high treatment coverage. The sensitivity and specificity estimates of VIA generally fall within the range of those reported for cytology and HPV testing. Randomized controlled trials evaluating test performance of VIA have demonstrated reduction in cervical cancer incidence and mortality in study population. The major limitation of VIA is that it is a subjective test and accuracy is dependent on the skill of trained providers. Low specificity and sub-optimal positive predictive value results in unnecessary referrals and/or treatment which can offset the perceived low cost of the test. VIA based screening programs are required to have clearly defined measurable indicators and a framework to identify the program strengths and weaknesses. Quality assurance of VIA is challenging specially because there is limited information on the test performance in multi-provider real programmatic setting. High quality training, periodic refresher courses, expertise of trained providers and close monitoring of performance indicators are required to ensure good quality VIA.
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