Value Of Visual Inspection With Acetic Acid And Logu's Iodine On Primary Screening For Cervical Cancer And Its Precancerous Lesions

As all we know,Cervical cancer is one of the most common malignant tumors among women.A substantial amount of studies have showed that high-risk human papilloma virus(HPV) types were highly relative to the incidence and development of cervical cancer and its precancerous lesion.At present,Screening is still the primary Measure to cervical cancer prevention and control.However,some developing countries lack scree -ning program,while other developing countries couldn't sustain their cytologybased screening program for lack of financial resources.And in those where the effective screening programmes are not developed,the incidence of cervical cancer is not under control.Unfortunately,the incidence is even ascending in places.At present,liquid-based cytology combined HR HPV DNAdetection is a worldwide rec-ommendatory programme for cervical caner screening.But the programme is too expensive to be used widespreadly in low resource settings.Scholars try to find new methods to screen cervical cancer,which are simple,low cost,feasiable and acceptable,including of Visual inspection with acetic acid and Logu's iodin e(VIA,VILI).By applying VIA and VILI to community women in shang -hai,Our study is to evaluate if VIA or VILI could be an economical and effective tool for cervical cancer and its precancerous lesions primary screening.Methods:1.Objects:In HongKou District of ShangHai,suitable women were invited to participate in our study.They should satisfy these conditions:age between 20y and 60y,not virgin,not in menses,not pregnant,no hysterectomy and plevic radioactivity therapy history,no acute genital inflammation,informed consent.2.Physical examination:Exclude the women with acute genital inflammation.3.visual inspection with acetic acid and Visual inspection with Logu's odine:The adjunctive reagents were 5%acetic acid and Logu's iodine.1-1.5 minute after the application of 5%acetic acid,we should diagnosis it.VILI have no time limit.4.Select the cervical specimens to detect high-risk HPV DNA(HC-Ⅱ),liquid-based cytology(LSIL and worse as positive) and PAP Smear.Part Of group A:select the cervical specimens to detect high-risk HPV DNA(HC-Ⅱ) and liquid-based cytology(LSIL and worse as positive);group B and remaining part of group A:Select the cervical specimens to PAP Smear.5.Indications for cervical biopsy(including ECC):1)Patients with VIA OR VILI positive.2)Patients with LSIL or worse;Patients withⅡb or worse;ASCUS with high-risk HPV DNA positive;3)Patients with Sscreening test Negative Voluntary to biopsy6.Treatment and Follow-Up:Those with pathology positive would be treated immediately.(＜1month),those with cytology or high-risk HPV DNA positive and pathology negative,or with pathology omitted,would be followed up7.Data analysis:SPSS11.0 dealt with the data.Sensitivity,specificity,positive predictive value,negative predictive value,accuracy,youden's index were calculated.The statistical significance was assessed by chi-square test.P＜0.05.Results:1.3631 women were involved in our study,with average age 46.3. Questionnaires show that women think it is acceptable to pay RMB284.3 to have a medical examination on their own account.In our study,100% women with pathology positive have hospital visit in 1month.Morbidity of cervial cancer and its precancerous lesion(≥CINⅠ) is 1845 /1000,000,Morbidity of cervial cancer and its high precancerous lesion(≥CINⅡ) is 845 /1000,000.The morbidity of HPV infection was 12.5%(148/1183).The morbidity of cervical HPV infection was 12.5%(27/216) in those with histology negative,58.1%(18/31) in those with low-grade CIN,90.9%(20/22) in those with high-grade CIN.There was high statistical significance among the group, severity of cervical disease is positively related with morbidity of HPV infection.There was no statistical significance berween premenopausal and menopausal women.2.The sensitivity of VIA for detecting cervical cancer and its high precancerous lesion was 85%,specificity 62.8%.The sensitivity of VILI was 90%,specificity 57.8%.There was no statistical significance in each index.3.Accoding to different manipulators,the sensitivity and specificity of VIA and VILI for detecting cervical cancer and its high precancerous lesion have no statistical significance between experienced group and inexperience group.There was no statistical significance between them in each index.4,the sensitivity and negatice predictive value of VIA for detecting cervical cancer and its high precancerous lesion have a high statistical significance between premenopausal and menopausal group.There was no statistical significance between them in specificity and positive predictive value.5.The sensitivity of HRHPV-DNA detection was 90.9%,specificity 81.8%,negative predictive value99%,positive predictive value 31%,Youden's Index0.73.The sensitivity of liquid-based cytology(LSIL and worse as positive) was84.6%,specificity73%,negative predictive value97.4%,positive predictive value29.7%,Youden's Index0.6.The sensitivity of PAP Smear was38.9%,specificity97.4%,negative predictive value96.7%positive predictive value41.2%,Youden's Index0.36.6.The specificity of VIA and PAP Smear detection was similar,butⅥA had bigger sensitivity.There was no statistical significance betweenⅥA and liquid-based cytology for detecting cervical cancer and its high precancerous lesion.The sensitivity ofⅥA and high-risk HPV DNA detection was similar,but high-risk HPV DNA detection had bigger specificity.Conclusions:1.The accuracy of VILI andⅥA for cervical cancer and its precancerous lesions screening are similar.ⅥA have time limit while VILI have no.2.The sensitivity and negative predictive value ofⅥA for detecting cervical cancer and its high precancerous lesion have high statistical significance between premenopausal and menopausal women.,SoⅥA and VILIare not applicable to menopausal women.ⅥA and VILI can be mastered easily by LMO(local medical offer),ⅥA and VILI are low cost,can be done repeatedly without equipment and laboratory workers.And it is screening-treat,which can avoid lost of follow up。ⅥA and VILI is a socially acceptable primary screening method and fit for primary community,especially suitable in low resource settings,which have clinical value. 3.Cervical cancer screening Programme containing liquid-based cytology and high-risk HPV DNA can have a longer screening interval and is fit for economically developed region and the wealthy.