文章摘要
王慧,王彤,胡尚英,赵方辉,张询,潘秦镜,章文华,李凌,乔友林.四种宫颈癌筛查方法的预测值比较[J].中华流行病学杂志,2013,34(2):191-194
四种宫颈癌筛查方法的预测值比较
Comparison on the predictive values of four screening methods regarding cervical cancer
收稿日期:2012-08-31  出版日期:2014-08-07
DOI:10.3760/cma.j.issn.0254-6450.2013.02.020
中文关键词: 宫颈肿瘤;筛检;人乳头瘤病毒;诊断试验;预测值
英文关键词: ervical neoplasia;Screening;Human papillomavirus;Binary diagnostic test;Predictive value
基金项目:国家自然科学基金(81072385);全国统计科研计划重点项目(2009LZ033)
作者单位E-mail
王慧 030001 太原,山西医科大学卫生统计学教研室  
王彤 030001 太原,山西医科大学卫生统计学教研室 wtstatl@sina.com 
胡尚英 中国医学科学院北京协和医学院肿瘤研究所医院流行病学研究室  
赵方辉 中国医学科学院北京协和医学院肿瘤研究所医院流行病学研究室  
张询 肿瘤医院病理科  
潘秦镜 细胞学室  
章文华 妇瘤科  
李凌 肿瘤医院病理科  
乔友林 中国医学科学院北京协和医学院肿瘤研究所医院流行病学研究室 qiaoy@cicams.ac.cn 
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中文摘要:
      以病理组织学诊断为金标准,比较宫颈癌筛查中5%醋酸染色肉眼观察法(VIA)、薄层液基细胞学(LBC)、人乳头瘤病毒(HPV)自体采样法和HPV医生采样法的预测值。首先采用联合假设检验方法比较四种筛检方法的阳性预测值(PPV)和阴性预测值(NPV),并对两预测值进行组间两两比较,再采用边际回归法和加权最小二乘法分别比较该两预测值,多重性调整采用Hochberg法。结果表明HPV医生采样法的NPV最高,LBC的PPV最高,均为有效的宫颈癌初筛方法,但后者需要有经验的细胞病理学家读片。HPV自体采样法的PPV和NPV均高于VIA,其PPV与HPV医生采样法相当,NPV与LBC相当,因该方法易得到受检者配合而有可能提高筛查依从性,成为一种简便、客观、易于重复和适宜在资源贫乏地区使用的宫颈癌初筛方法。
英文摘要:
      To compare the predictive values of 5% acetic acid stain and visual inspection,human papillomavirus (HPV) Self test, ThinPrep Pap and HPV direct test in screening for cervicalcancer with biopsy as gold standard. Positive predictive values and negative predictive values werecompared simultaneously by joint hypothesis tests and then either positive predictive values ornegative predictive values of the any two screening tests were compared by marginal regression basedon both GEE and weighted least square methods. Hochberg method was used for multiplicityadjustment. It was showed that HPV direct test had the highest negative predictive value and ThinPrepPap the highest positive predictive value. 5% acetic acid stain and visual inspection had both thelowest positive predictive value and negative predictive value. Both HPV direct test and fhinPrep Papwere effcient, but the latter required compatible infrastructure and skilled caregivers to go with. Both5% acetic acid stain and visual inspection were inexpensive, and their positive predictive value andnegative predictive value were lower than HPV self-test. They also had similar positive predictivevalue with HPV direct test and similar negative predictive value with ThinPrep Pap. HPV self-testappeared to be efficient, suggesting that it had significant potential for screening program to beimplemented in the rural areas of China since the test could be performed without speculumexamination in low-resource regions
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