摘要:Objective It is to find out cervical cancer screening algorithms suitable for economically underdeveloped areas or grassroots health institutions ,in order to expand the coverage of cervical cancer screening and promote the prevention and control of cervical cancer in China .Methods 167 women were voluntary to undergo the cervical cancer screening included Fo -late receptor mediated methylene blue dye staining (FRD) and Thin-Cytologic Test(TCT).Each woman underwent colposcopy and biopsy or endocervical curettage .Screening results were evaluated by the gold standard based on histopathological diagno -sis.The performance indexes of the algorithms such as sensitivity , specificity , positive predictive value , negative predictive value ,and receiver operating characteristic (ROC) curve for detecting the high grade lesions (≥CIN2)were compared.Re-sults For the FRD as the screening test , its sensitivity was 91.0%, specificity was 75.7%, positive predictive value was 21. 4%, and negative predictive value was 99.2%.For the TCT as the screening test , its sensitivity was 79.3%,specificity was 90.4%,the positive predictive value was 37.1%, and the negative predictive value was 98.4%.There was no statistically significant differences in ROC area under the curve between the two methods (Z=0.559, P>0.05).For the combination test of FRD and TCT as the screening test ,the sensitivity ,specificity ,positive predictive value and negative predictive value were 100.0%73.8%, 21.3% and 100.0% respectively.Combination test of FRD and TCT was obviously superior to the screening test of FRD alone , and the difference was statistically significant (Z=1.825, P<0.05);There was no statistically significant differences between the combination test and TCT alone (Z=0.797, P>0.05). Conclusion Screening test of FRD is suitable for underdeveloped regions with large population and grassroots health institutions with insufficient medical technology .Considering the health-resource and women ' s preference , combination test of FRD and TCT may be chosen as the screening approach in developed regions .%目的 探索适合我国经济不发达地区及基层卫生机构宫颈癌筛查的方案,提高我国宫颈癌筛查的覆盖面及宫颈癌防治水平. 方法 对1 671例接受宫颈癌普查对象进行叶酸受体介导的亚甲蓝染色(FRD)及宫颈薄层液基细胞学检查(TCT),并均行阴道镜检查及宫颈活检 ,阴道镜检查不满意者同时行宫颈管刮术. 以病理检查结果为金标准判断FRD及 TCT单独应用及联合应用的筛查结果,比较各方案的敏感度、特异度、阳性预测值、阴性预测值. 以受试者工作特征曲线( ROC)下面积综合分析各筛查方案. 结果 FRD筛查方法敏感度为91.0%,特异度为75.7%,阳性预测值为21.0%,阴性预测值为99 .2%. TCT筛查方法的敏感度为79 .3%,特异度为90 .4%,阳性预测值为37 .1%,阴性预测值为98 .4%. 2种方法ROC曲线下面积比较差异无统计学意义(Z=0.559,P>0 .05). 联合筛查方案的敏感度为100.0%,特异度为73.8%,阳性预测值为21.3%,阴性预测值为100.0%. 联合方案ROC曲线下面积明显优于单纯FRD筛查( Z=1.825,P<0.05),但与TCT筛查比较差异无统计学意义(Z=0.797,P>0.05). 结论 FRD筛查可以用于人群基数大、经济欠发达或医疗技术相对落后地区的宫颈癌筛查,以提高我国宫颈癌筛查的覆盖面;对于有条件的医疗机构或人群,也可以采用FRD联合TCT的筛查方案,以进一步提高宫颈癌筛查的效力.