Comparison Of Methods In Early Screening Cervical Cancer

Objective To assess the test qualities of five screening methods to detect cervical intra-epithelial neoplasia and cervical cancer in Xiushui ,a rural county of Jiangxi Province, with a high incidence of cervical cancer. Methods Between October and November 2004, 2500 women in the age group 30-49 years underwent concurrently five screening methods: HPV DNA testing , ThinPrep cytologic test, visual inspection with 5%acetic acid (VIA), visual inspection with lugol's iodine(VILI) and colposcopic evaluation based on the pathology results as a gold standard. Results 1879 eligible women were included in this study, biopsies showed that the prevalence of HSIL and cancer of cervix was 4.15%(78/1879).Using biopsy results as a gold standard(≥CIN2),the sensitivity(Se),specificity(Sp), efficiency(E),positive predictive value(PPV),negative predictive value(NPV),Youden's index and Kappa value of each diagnostic test were listed respectively as following: ThinPrep cytologic test(0.833,0.970,0.964,0.546,,0.993,0.803,0.642), HPV DNA testing(0.974,0.856,0.861,0.227,0.998,0.830,0.322), visual inspection with 5%acetic acid (VIA)( 0.577,0.944,0.929,0.308,0.981,0.521,0.368), visual inspection with lugol's iodine(VILI)( 0.342,0.967,0.941,0.310,0.972,0.313,0.296), colposcopic evaluation(0.372,0.982,0.957,0.468,0.973,0.363,0.392). An analytic sensitivity of 1.0 pg/mL using the second generation assay permitted detection of 89.53%CIN1,97.26%CIN2-3,100%cancer,The omission diagnostic rate of HPV DNA testing and ThinPrep cytologic test was 2.56%(2/78)and 16.67%(13/78)(P<0.05)respectively, The omission diagnostic rate of ThinPrep cytologic test was higher than that of HPV DNA testing. Conclusions HPV DNA testing was evaluated better than any other screening methods, which had a very high sensitivity for the detection of cervical cancer precursors (≥CIN2) and cancer, and is a promising approach. ThinPrep cytologic test also was evaluated well in all index, and is suitable for cervical cancer screening test. Because VIA,VILI and colposcopic evaluation are essentially subjective , their sensitivity and specificity varied greatly, for purpose of standardization, uniform criteria for reporting and diagnosing visual tests remains to be established. quality control should be strenghtened, and assuring the quality of visual screening methods in field conditions can be a challenge, the thoroughness of training for test providers maybe of important. In summary, further conclusive evaluation of visual tests and colposcopy should do in other settings.