| Background:Cervical cancer is one of the highest incidences of gynecological malignancies. Cervical cancer screening for early diagnosis and treatment of cervical cancer is essential.At present, there are many cervical cancer screening methods, such as, Pap smears, TCT, Visual inspection with acid, Visual inspection with Lugol iodine, the application of colposcopy, HPV-DNA testing, Colposcopic Cervicography online image-reading technology. But different screening methods apply to different countries and populations. In this paper, we will make an objective assessment of Colposcopic Cervicography online image-reading technology on community-based cervical cancer screening.Methods:In Hongkou District of Shanghai, suitable women were invited to participate in our study. Screening methods are as follows:1.Pap smears,2. VIA/VILI,3. Colposcopic Cervicography online image-reading. Cervical biopsy (including ECC) is done when any of the results is positive.Further treatment is followed for those with CIN or cervical cancer and regular screening is carried out for those without CIN or cervical cancer. We use EXCEL and SPSS19.0to finish data processing and statistical analysis. We use pathological diagnosis as the gold standard to calculate and compare sensitivity, specificity, positive predictive value, negative predictive value of above-mentioned methods. We compare the results of the first reading and the second reading by the same examiner. We compare the time spent by VIA/VILI and Colposcopic Cervicography online image-reading. The statistical significance was assessed by chi-square test. P<0.05is considered as significant.Results:3811were involved in our study,521biopsies were done,22CIN Ⅰ,15CINⅡ,7CINⅢ,1CINⅡ-class involving gland,1CINⅢ-class involving gland, cervical microinvasive carcinoma Phase I,1cervical carcinoma in situ involving glands were found. The sensitivity of VIA-online, VILI-online, VIA-online and VILI-online, Pap smear, VIA, VILI, VIA and VILI, online image-reading and Pap smear, visual inspection and Pap smear to diagnose CIN and cervical cancer is83.33%、82.98%、85.42%、29.17%、70.80%、75.00%、77.08%、77.08%、87.50%. Specificity is60.68%、54.55%,52.43%、93.23%、53.70%、43.76%、38.27%、51.16%、37.00%. Positive predictive value is17.70%、15.35%、15.41%、30.43%、13.44%、11.92%、11.25%、15.38%、11.04%. Negative predictive value is97.29%、96.63%、97.25%、92.48%、94.78%、94.52%、94.27%、97.58%、94.09%. The sensitivity of online image-reading, visual inspection and Pap smears to diagnose high grade CIN is92.3%、76.9%、38.46%,specificity is51.11%、37.58%、93.23%, positive predictive value is9.00%、6.00%、23.81%, negative predictive value is99.22%、96.88%、96.50%. The sensitivity of online image-reading, visual inspection and Pap smears to diagnose low grade CIN is77.27%、81.82%、31.82%, specificity is77.27%,81.82%,31.82%, positive predictive value is7.00%、5.77%、17.95%, negative predictive value is98.02%、97.80%、96.71%. The sensitivity of online image-reading is higher than that of Pap smear (x2=54.08, P<0.05), but while compared with visual inspection, there is no statistical significance (x2=1.09, P>0.05). The specificity of online image-reading is higher than that of visual inspection (x2=18.37, P<0.05).The specificity of Pap smear is higher than that of online image-reading, and higher than that of visual inspection (X2>40, P<0.05). The above conclusions apply equally to high grade CIN. Online image-reading united Pap smear screening cannot improve the sensitivity (X2=0.00, P>0.05), but it can improve the specificity (X2>40, P<0.05). There is no statistical significance between the result of the first online image-reading and the second online image-reading (P>0.05). And there is no statistical significance between the result of the beginner and experienced physician. For visual and online image-reading, the sensitivity and specificity to premenopausal women are both higher than that to postmenopausal women.Conclusions:1. Colposcopic Cervicography online image-reading technology has higher sensitivity and specificity in community-based cervical cancer screening. It can be easily mastered and it is low cost. It is repeatability. It has the advantage of saving time, operating easily. It can get better quality control. A community physician can collected cervical photographic images, and many doctors can read it online, and even experts can conduct tele-consultation. It can increase the detection rate of CIN and cervical cancer, and reduce missed diagnosis and misdiagnosis, at the same time reduce patient suffering. So Colposcopic Cervicography online image-reading technology can be an effective primary screening test for community-based cervical cancer screening and can replace Pap smear and visual inspection.2. Colposcopic Cervicography online image-reading technology has inadequate, and it cannot be applied to all screening. So further examinations, such as Pap smear or TCT or HPV-DNA testing, are needed. And there should be the internet dedicated website. |
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