肺癌不同阳性标准痰细胞学筛查方法的灵敏度和特异度分析  

Analysis of sensitivity and specificity of sputum cytology screening for lung cancer with different positive criteria

作　　者：姜勇[1] 晋萍[2] 常润生 姚树祥[4] 周清华[5] 范亚光 乔友林[1] 

机构地区：[1]中国医学科学院肿瘤研究所,北京100021 [2]云南省肿瘤医院 [3]云南省个旧市红河州第三人民医院 [4]昆明医学院公共卫生学院 [5]天津医科大学总医院天津市肺癌研究所天津市肺癌转移与肿瘤微环境重点实验室

出　　处：《中华预防医学杂志》2011年第7期605-608,共4页Chinese Journal of Preventive Medicine

基　　金：美国国立癌症研究所科研项目（263-MQ-014567）;国家“十五”科技攻关课题（2001BA703811）

摘　　要：目的探讨改变阳性标准对职业高危人群肺癌痰细胞学筛查灵敏度及特异度的影响。方法以1992-1999年间至少参加过1次年度性痰细胞学肺癌筛查的云南锡矿工人为研究对象，共9223名。研究对象年龄均40岁以上、井下工龄或冶炼工龄超过10年且无恶性肿瘤史。收集研究对象痰样进行筛查，以筛查阳性且被临床确诊的肺癌患者为真阳性，筛查阴性且在随访期间没有被临床诊断为肺癌的研究对象为真阴性，计算不同阳性标准痰细胞学筛查方法的灵敏度、特异度，并进行受试者工作特征曲线（ROC曲线）分析，利用Hanley和McNeil法计算z值，比较不同阳性标准ROC曲线下面积的差别。结果截止到随访终止时间（2001年12月31日），9223名研究对象中共有500例肺癌患者，最常见的细胞类型为鳞癌[55．8％（222／398）]，发病部位以中央型肺癌为主[68．5％（316／461）]。在筛查过程中，共150例患者有痰细胞学筛查阳性史。阳性标准分别为重度不典型增生及以上、中度不典型增生及以上、轻度不典型增生及以上时，痰细胞学筛查方法灵敏度分别为30．0％（150／500）、36．4％（182／500）、53．0％（265／500）；特异度分别为98．9％（8628／8723）、95．1％（8611／8723）、77．9％（7033／8723）。3种阳性标准的ROC曲线下面积（由重度到轻度y分别为0．645（95％CI：0．635～0．654）、0．657（95％CI：0．668～0．667）、0．655（95％CI：0．645～0．664）；重度与中度、轻度比较，以及中度与轻度比较，差异均无统计学意义（Z值分别为0．780、0．645、0．209，P值均〉0．05）。结论随阳性标准的降低，痰细胞学筛查的灵敏度上升而特异度下降，但3种不同阳性标准的准确度并无明显差异。Objective To discuss the effect of different positive criteria on the sensitivity and specificity of sputum cytology screening for lung cancer among Yunnan tin miners. Methods 9223 Yunnan tin miners who received at least one annual sputum cytology screening for lung cancer during the period between 1992 and 1999 were recruited in the study. At time of enrollment, all participants were aged over 40 years old,had at least 10 years of employment as an underground miner and（or） smelter, and had not been diagnosed with malignancy. In our study, a true positive was categorized as having at least one prior positive sputum screening and a diagnosis of lung cancer, while a true negative, by our definition, signified negative sputum examinations and no diagnosis of lung cancer during the follow up time. Based on different positive criteria, sensitivity and specificity of sputum cytology were computed and receiver operating characteristic（ROC） curve analysis was conducted. Z statistic was used to test the differences of the area under ROC based on Hanley and McNeil method. Results By the end of following up on December 31,2001,a total 500 lung cancer cases were diagnosed among 9223 participants： most were squamous cell carcinoma （55.8% （222/398）） and central lung cancers （68.5% （316/461） ）. 150 lung cancer cases had a previous positive sputum screening result. When positive criteria were taken as grave atypical metaplasia,moderate atypical metaplasia and slight atypical metaplasia, the corresponding sensitivities were 30.0% （ 150/500 ）, 36. 4% （ 182/500 ）, 53. 0% （ 265/500 ） respectively; while the corresponding speeificities were 98.9% （ 8628/8723 ） , 95.1% （ 8611/8723 ） , 77.9% （ 7033/8723 ） respectively. The areas under ROC curve according to different positive criterias were 0. 645 （95 % CI： 0. 635 -0. 654）, 0. 657 （95% CI： 0. 668 - 0. 667 ） , 0. 655 （ 95% CI： 0. 645 - 0. 664 ） respectively. There were no significant differences found in the comparisons

关 键 词：肺肿瘤 痰 细胞学技术 敏感性与特异性 

分 类 号：R734.2[医药卫生—肿瘤]