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[目的]探讨两次醋酸染色肉眼观察(VIA)在宫颈癌筛查中的应用价值。[方法]2011年对2463名河南省新密市25～65岁的妇女进行HPV检测、VIA的联合筛查,任一筛查阳性者和10%随机抽取的筛查阴性者共855名妇女进行第二次VIA和阴道镜检查。[结果]最终完成两次VIA、阴道镜检查及宫颈活检的855名妇女,其中未绝经组561人,绝经组294人。未绝经组和绝经组第一次VIA的阳性率分别为19.8%(111/561)和7.1%(21/294),灵敏度分别为59.1%和20.0%,特异性分别为81.8%和93.6%。未绝经组和绝经组进行第二次VIA的阳性率分别为15.7%(88/561)和5.8%(17/294)。未绝经组和绝经组进行两次VIA检查总的阳性率分别为27.3%和10.2%,两次VIA检查并联的灵敏度分别为81.8%和40.0%,特异性分别为75.0%和91.4%。未绝经组通过两次VIA检查比单独一次VIA检查多发现5例CIN2+的漏诊病例(1例CIN2,4例CIN3),绝经组通过两次VIA检查比单独一次VIA检查多发现3例CIN3的漏诊病例。[结论]宫颈癌筛查中,两次VIA检查不仅可以明显提高单次VIA检查的灵敏度,还可以发现单次VIA检查漏诊的高度CIN病例。两次VIA在未绝经女性宫颈癌筛查中的价值优于绝经组。
[Objective] To investigate the value of two acetic acid staining visual inspection (VIA) in cervical cancer screening. [Methods] In 2011, a total of 855 women from 2563 women aged 25-65 in Xinmi, Henan Province, underwent HPV testing, VIA combined screening, any screening positive, and 10% of screening negative patients randomly selected Second VIA and colposcopy. [Results] The final complete VIA, colposcopy and cervical biopsy of 855 women, including 561 non-menopause group, 294 menopause group. The positive rates of the first VIA in non-menopausal and postmenopausal women were 19.8% (111/561) and 7.1% (21/294) respectively, with sensitivities of 59.1% and 20.0% and specificity of 81.8% and 93.6%, respectively. The second VIA positive rate was 15.7% (88/561) and 5.8% (17/294) in the non-menopausal and menopausal groups, respectively. The total positive rates of two VIA tests in non-menopausal and postmenopausal women were 27.3% and 10.2%, respectively. The sensitivity of the two VIA tests in parallel was 81.8% and 40.0%, and the specificity was 75.0% and 91.4% respectively. Five cases of missed diagnosis of CIN2 + (one case of CIN2 and four cases of CIN3) were found in two non-menopausal groups compared with VIA alone. Misdiagnosis of three cases of CIN3 was found in two men with menopausal VIA compared with VIA alone Case. [Conclusions] In cervical cancer screening, two VIA tests can not only significantly improve the sensitivity of single VIA examination, but also find a high degree of CIN cases missed by single VIA. Two VIA in premenopausal women with cervical cancer screening value is better than the menopause group.