| ObjectiveAnalyze, discuss the effects of preliminary screening of visual inspection with acetic acid, visual inspection with Logu’s iodine and high risk human papilloma virus inspection to cervix pathological changes of rural women, and evaluate its value as the tools of preliminary screening of cervical carcinoma and precancerous lesion in rural communitiesMethods1. Objects of study:permanent residents in the community of Nanma Town, Yiyuan County, Shandong Province, a mountainous area in Yimong Region, as target population.Inclusion criteria:people having sexual life, not in menstrual period, not in pregnant period, no complete hysterectomy history, no pelvic irradiation history, willing to participate and accept inspection.2. Choosing Nanma Town Hospital, Yiyuan County, Shandong Province, as the elementary community medical institution, and conducting training to its staff on cervical cancer screening and diagnosis and treatment of cervical lesions. Before formal inspection, it is beneficial to introduce cervical cancer prevention and potential possibility of curing it, improve the cognize of cervical cancer of the local women, and realize the benefits of screening of cervical cancer. At the same time carries on the questionnaire survey, and sign the informed consent.3. The screening population was divided into two groups, The first group underwent gynecological examination, the acetic acid test/iodine test visual observation (VIA/VILI) and HPV-DNA (HC Ⅱ); The second groups underwent gynecological examination, the conventional cervical smear cytology (Pap smear) and HPV-DNA (HC Ⅱ).4. Choosing Yiyuan County People’s Hospital as secondary medical institution for cervical cytology smears in the diagnosis of TBS, conducting colposcopy inspection on the abnormals, making biopsy and histopathological examination on the basis of colposcopy inspection.5. Choosing Qilu Hospital of Shandong University as the tertiary medical institution, using the HC Ⅱ method for HPV-DNA detection, review of cytologic smear and histopathological slices.Result1.3763rural women were screened in this study, aged25-65。Questionnaire survey shows20%knowledge awareness rate,5%having received cervical cancer screening, pathological diagnosis of CINⅠ22cases, CIN118cases, CINⅢ3cases. Uterine cervical precancerous lesions (> CINI) indicates a prevalence of877/100000, uterine neck height intraepithelial neoplasia (≥CINⅡ) a prevalence of292/100000. In low grade cervical precancerous lesions (CINⅠ) group, for women under35, positive rate was2.55%(9/353), for women over the age of35the positive rate was0.38%(13/3410), the difference was statistically significant (χ2=21.62, P<0.01); In high grade cervical precancerous lesions (> CINⅠ) group, for women under35, positive rate was0.85%(3/353), for women over the age of35, the positive rate was0.23%(8/3410); the difference was not statistically significant (χ2=2.28, P>0.05). In low grade cervical precancerous lesions group, for people under the age of35the proportion was40.91%(9/22); In high grade cervical precancerous lesions group, for women under35, the proportion was27.27%(3/11); no significant differences (χ2=1.92, P0.05).2. In the screened group HR-HPV infection rate was11.08%, HR-HPV infection rate is the highest among the population under the age of35, lowest among the population over the age of60. The difference between different ages was not statistically significant (χ2=3.15, P>0.05). HR-HPV levels in cervical lesions in infection rates were normal or inflammation34.84%, CINⅠ81.82%, CINⅡ87.50%, CINⅢ100%.3. Take organize pathology as the gold standard, HCⅡ HPV DNA test in the screening of cervical lesions with a sensitivity of84.85%, specificity of89.58%, positive predictive value of6.71%, and negative predictive value of99.85%, accuracy of89.53%, Youden index0.74. Acetic acid/iodine experiment visual observation method in screening of cervical lesions with a sensitivity of75%, specificity of63.96%, positive predictive value of2.19%, and negative predictive value of99.58%, accuracy of64.08%, Youden index0.39. Cervical smear cytology in screening of cervical lesions of the sensitivity61.53%, specificity of96.95%, positive predictive value12.31%, negative predictive value99.72%, accuracy of96.70%, Youden index0.58.4. Comparison of HPV DNA detection method with acetic acid/iodine test visual observation method in screening of cervical cancer and precancerous lesions of sensitivity (χ2=0.789, P>0.05), and negative predictive value (χ2=0.641, P>0.05), no significant difference; specificity (χ2=530.1, P<0.01), the positive predictive value (χ2=14.19, P<0.01), accuracy (χ2=528.9, P<0.01), there were significant differences. Comparison of HPV DNA detection method with the traditional cytological screening for cervical cancer and precancerous lesions of sensitivity (χ2=2.979, P>0.05), the positive predictive value (χ2=2.545, P>0.05), and negative predictive value (χ2=0.002, P>0.05), no significant differences in specificity (χ=92.39, P<0.01), accuracy (χ2=86.92, P<0.01), there were significant differences. Comparison of conventional cytology and acetic acid/iodine test visual observation method in screening of cervical cancer and precancerous lesions of sensitivity (χ2=0.676, P>0.05), and negative predictive value (χ2=0.444, P>0.05), no significant difference; specificity (χ2-645.9, P<0.01), positive predictive value of (χ2=20.49, P<0.01), accuracy (χ2=635.1, P<0.01), there were significant differences.5. In this study, the physicians in the secondary medical institution first conducted elementary pathological on cervical tissues. Then the tertiary medical institution reviewed the diagnoses. The diagnostic coincidence rate was60%(12/20), the false positive rate of40%(8/20), false negative rate is1.5%(2/134). Cytological diagnosis also were first conducted by secondary medical institutions, and then reviewed by the tertiary medical institutions. Positive coincidence rate was44.8%(30(67), the false positive rate was55.2%(37/67), and the false negative rate was1.2%(16/1305). Conclusion:1. Due to high rate of false positive of the acetate/iodine experiment visual observation and low positive predictive value, it is not suitable in rural communities as the cervical cancer screening method.2. Under the limitation of cytological techniques and medical technology level of the cytology diagnosis, the efficiency of the screening of cervical cancer cytology method in the rural community is rather low, unsuitable as a screening method.3. The high risk HPV DNA detection with high sensitivity and negative predictive value, as a screening test it can improve the screening efficiency, has the potential to save medical resources. In rural communities it is a suitable cervical cancer screening method. Cytology can be used as a secondary diffluence method after HPV detection.4. In the primary hospital should not carry out "check namely namely governance" model of diagnosis and treatment. |
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