多种检查方法在宫颈病变筛查中的临床应用分析  

Application of Several Inspection Methods in Cervical Lesions Screening

作　　者：施华珍[1] 曹树军[1] 陈晓玲[1] 

机构地区：[1]上海市第一人民医院松江分院,201600

出　　处：《中国全科医学》2011年第21期2357-2359,共3页Chinese General Practice

摘　　要：目的对比分析多种常用筛查方法早期诊断宫颈癌的临床价值。方法病例来源于2010年4月1日—11月30日来我院宫颈门诊就诊的患者,收集门诊巴氏涂片细胞学检测、液基细胞学检测、阴道镜检查及人乳头瘤病毒(HPV)免疫组化检测的资料共1 000例,以病理检查结果为金标准,对比分析4种方法的敏感性、特异性、准确性、阳性预测值、阴性预测值、似然比及约登指数。结果 (1)宫颈巴氏涂片细胞学检测、液基细胞学检测、阴道镜检查、HPV检测诊断宫颈病变的敏感性分别为44.4%、86.8%、53.1%和98.0%;特异性分别为96.1%、91.9%、83.1%和94.8%;准确性分别为89.7%、91.1%、80.2%和95.1%;阳性预测值分别为62.1%、66.0%、25.5%和67.1%;阴性预测值分别为92.4%、97.5%、94.2%和99.8%。(2)宫颈巴氏涂片细胞学检测、液基细胞学检测与阴道镜检查联合筛查诊断宫颈病变的敏感性分别为74.3%和92.9%;阴性预测值分别为95.6%和97.9%;特异性分别为67.8%和68.0%。结论液基细胞学检测及HPV免疫组化检测诊断宫颈癌的准确性最高,联合检查可以使其敏感性明显提高,漏诊率明显下降;液基细胞学与阴道镜联合检查更具优势,值得推广。Objective To compare the clinical value of common screening methods in the early diagnosis of cervical cancer.Methods A total of 1 000 cases of outpatient who underwent pap smear cytological examination,liquid base cytological（TCT） examination,colposcopy（COL）,and HPV immunohistochemical detection at our cervical clinic between April 1st,2010 and November 30th,2010 were enrolled.Sensitivity（Se）,specificity（Sp）,positive predictive value（PPV）,and negative predictive value（NPV） among these inspection methods were compared,with pathological examination deemed as the gold standard.Results Se of cervical pap smear cytological examination,liquid base cytological examination,colposcopy,and HPV detection were 44.4%,86.8%,53.1%,and 98.0%;Sp were 96.1%,91.9%,83.1%,and 94.8%;E value were 89.7%,91.1%,80.2%,and 95.1%;PPV were 62.1%,66.0%,25.5%,and 67.1%;NPV were 92.4%,97.5%,94.2%,and 99.8%,respectively.Se for pap smear-TCT and COL-TCT combination were 74.3% and 92.9%;NPV were 95.6% and 97.9%;Sp were 67.8% and 68.0%,respectively.Conclusion Liquid base cytological examination and HPV immunohistochemical detection showed the supreme accuracy,while joint inspection might yield higher sensitivity with declined rate of missed diagnosis.Joint inspection of liquid base cytology and colposcopy is worth promotion.

关 键 词：宫颈肿瘤 筛查 诊断技术和方法 

分 类 号：R711.74[医药卫生—妇产科学]