title: Evaluation of several screening approaches for detection of cervical lesions in rural Shandong, China.
abstract: OBJECTIVE
  The study was designed to: (1) investigate the prevalence of high-risk human papillomavirus (HR- HPV) infection and cervical neoplasia; and (2) evaluate clinical performance of visual inspection with acetic acid/ Lugol's iodine (VIA /VILI), Pap smear, high-risk human papillomavirus (HR-HPV) DNA test for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and (3) explore appropriate screening approach in rural areas of Shandong Province.
  
  
  METHODS
  A total of 3,763 eligible women from Yiyuan County in Yimeng mountainous areas of rural Shandong, China, were enrolled and underwent Pap smear, HR-HPV DNA testing by Hybrid Capture 2 (HC2), and VIA /VILI tests. Women positive in any test were referred to colposcopy and biopsy as indicated.
  
  
  RESULTS
  The prevalence of HR-HPV infection among all enrolled women was 11.1% and that in healthy women was 9.9%. In total 33 cases of CIN1, 16 cases of CIN2, 6 cases of CIN3 but none of cervical cancer were detected and the crude prevalence of CIN2+ was 0.58%. For detecting CIN2+, the sensitivity of HR-HPV DNA testing, VIA/VILI, Pap smear was 90.9%, 77.3%, 81.8%, respectively. Pap smear had the best specificity of 98.2%, followed by HR-HPV DNA testing with specificity of 89.4%, VIA/VILI had the lowest specificity of 81.2%. Colposcopy referral rate of HR-HPV DNA testing, VIA/VILI, Pap smear was 11.1%, 18.5%, 2.3%, respectively.
  
  
  CONCLUSIONS
  Our results suggest that HR-HPV DNA testing alone might be appropriate for primary cervical cancer screening in rural low-resource areas of Shandong Province, China.
authors.affiliation: Department of Gynecology and Obstetrics, Qilu Hospital of Shandong University, Jinan, People's Republic of China E-mail zhangyouzhong@sdu.edu.cn.
authors.forename: Li-Ju
authors.initials: LJ
authors.lastname: Zong
authors.forename: You-Zhong
authors.initials: YZ
authors.lastname: Zhang
authors.forename: Xing-Sheng
authors.initials: XS
authors.lastname: Yang
authors.forename: Jie
authors.initials: J
authors.lastname: Jiang
authors.forename: Bao-Xia
authors.initials: BX
authors.lastname: Cui
authors.forename: Yun-Bo
authors.initials: YB
authors.lastname: Qiao
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Kan
authors.initials: K
authors.lastname: Jiang
authors.forename: Wen-Jing
authors.initials: WJ
authors.lastname: Zhang
authors.forename: Bei-Hua
authors.initials: BH
authors.lastname: Kong
authors.forename: Keng
authors.initials: K
authors.lastname: Shen
mesh_terms: D019342:Acetic Acid; D000328:Adult; D052685:Alphapapillomavirus / Q000235:genetics; D002681:China / Q000453:epidemiology; D004279:DNA, Viral / Q000302:isolation & purification; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D061809:Human Papillomavirus DNA Tests / Q000379:methods*; D006801:Humans; D007454:Iodides; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D065006:Papanicolaou Test / Q000379:methods; D030361:Papillomavirus Infections / Q000453:epidemiology; D012423:Rural Health; D012424:Rural Population; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
chemical_list: D004279:DNA, Viral; D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution