An Evaluation Of Five Screening Methods For The Early Detection Of Cervical Neoplasia And Cervical Cancer

ObjectiveThis study is designed to evaluate five cervical cancer screening methods and build an effective screening strategy.MethodsA total of 1005 women aged 25-65 were selected from Lishui, where cervical cancer is highly prevalent in Zhejiang province, and 859 subjects were finally enrolled between June 2009 and December 2009. Each objective was subjected to five screening methods, including Pap smear, Liquid-based cytology(LBC), human papillomavirus DNA with a second-generation hybridization assay (HC2).visual inspection with acetic acid(VIA), and visual inspection with Lugol's iodine(VILI). CIN2+ on biopsy was used as the reference standard for disease positivity. Negative colposcopy was accepted as negative outcome. ResultOf the 859(85.9%) women including in our study, mean age was 39.8 years old, 20.3%(174/859) began sex intercourse before 21,38.2%(328/859) has two or two more sex parters,15.4%(132/859) haven't attended screening within one year, and 2.4%(21/859) never experienced cervical screening. Pathological examination found no cases of cervical cancer. The estimated prevalence of CIN 2 or higher was 1.9% (16/859). HC2 shows the highest sensitivity(83.5%), but relatively low specificity. The sensitivity of Pap smear is quite low in our study. VILI shows the same sensitivity as LBC. The sensitivity(Se),specificity(Sp), positive predictive value (PPV),negative predictive value (NPV) were 25%,90%,26.7% and 98.6% for Pap smear; 81.3%, 97.3%, 35.1% and 99.6% for LBC; 68.9%,82.8%,7.1% and 99.3% for VIA; 81.3%, 84.6%,9.1% and 99.3% for VILI;87.5%,77.3% and 6.8% for HPV-DNA testing respectively.ConclusionLBC was associated with the better balance of sensitivity, specificity and predictive value of the five screening.,which has the potential to optimize the effectiveness of primary cervical cancer screening. VIA screening, in the presence of low cost and facility of operation, is an effective method to screen cervical cancer in less-developed place. The sensitivity of cytology and HPV testing was increased significantly when combined with VIA or VILI.