宫颈脱落细胞学检查高级别异常在阴道镜拟诊中的价值研究  

Value of high-risk cervical cytological abnormalities in colposcopy diagnosis

作　　者：赵健[1] 郭雯雯[2] 杜亿杉 杨波 王婷婷 马德勇[1] 冯慧[1] 胡尚英 ZHAO Jian;GUO Wen-wen;DU Yi-shan;YANG Bo;WANG Ting-ting;MA De-yong;FENG Hui;HU Shang-ying(Department of Gynecology and Obstetrics,Peking University First Hospital,Beijing 100034,China;不详)

机构地区：[1]北京大学第一医院妇产科,北京100034 [2]肇庆医学高等专科学校,广东肇庆526040 [3]北京大学医学部药学院,北京100034 [4]北京大学医学部国际合作交流中心,北京100034 [5]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院,北京100021

出　　处：《中国实用妇科与产科杂志》2020年第9期850-854,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家自然科学基金(81773533)。

摘　　要：目的探讨宫颈脱落细胞学检查高级别异常结果在阴道镜拟诊中的价值。方法选取2014年9月至12月北京大学第一医院妇产科TTR-way数据库中1050例宫颈脱落细胞学检查(TCT)诊断结果为意义未明的不典型鳞状细胞(ASCUS)及以上的病例,回顾分析患者的病理组织分布情况;通过计算灵敏度、特异度、阳性/阴性预测值和约登指数,并绘制ROC曲线,计算ROC曲线下面积,评价采用单独阴道镜检查、单独细胞学高级别异常与二者联合筛查在识别宫颈上皮内瘤变(CIN)2+的能力方面的差异。结果1050例细胞学ASCUS及以上转诊阴道镜患者中,CIN2+患者共338例(32.19%),其中子宫颈癌39例,原位腺癌1例,HSIL/CIN3122例(11.62%),HSIL/CIN2176例(16.76%);单独凭借阴道镜筛查可检出254例的CIN2+患者,漏诊率为24.58%;筛检CIN2+的灵敏度为75.15%,特异度为97.75%,阳性预测值为94.07%,阴性预测值为89.23%;阴道镜筛查联合TCT高级别异常检查结果,可共识别出312例的CIN2+患者,漏诊率仅为7.69%,灵敏度为92.31%,特异度为82.02%,阳性预测值为70.91%,阴性预测值为95.74%;阴道镜联合TCT高级别异常筛查的AUC(87.17%)大于单独阴道镜(86.45%)和单独TCT筛查(72.70%)。结论阴道镜拟诊中结合TCT高级别异常检查结果提高了识别宫颈高级别病变的能力。Objective To evaluate the role of cervical cytology in the process of colposcopic impression.Methods A total of 1050 cases withundefined atypical squamous cells(ASCUS)and above cytology,were selected from the TTR-way database of the department of obstetrics and gynecology,Peking University first hospital from September 2014 to December 2014,and their pathological tissue distribution was retrospectively analyzed.The report evaluates the significant differences in identifying high-grade cervical intraepithelial neoplasia(CIN2+)condition among single colposcopy,single high-grade abnormal cervical cytology and combined procedure of both colposcopic impression and high abnormal cervical cytology through NPV,PPV,sensitivity,specificity and Jordon index,as well as ROC curve to identify the condition.Results Among 1050 ASCUS cases which were diagnosed by colposcopy,338 cases were CIN2+(32.19%),of which 39 cases were cervical cancer and 1 case was adenocarcinoma in situ;122 cases were HSIL/CIN3(11.62%)and 176 cases were HSIL/CIN2(16.76%).By colposcopy impression procedure alone 254 patients were identified with CIN2+,with a missed diagnosis rate of24.58%,the sensitivity being 75.15%,specificity 97.75%,positive predictive value 94.07%,and negative predictive value 89.23%.By combined procedure of both colposcopy impression and high-grade abnormal cervical cytology procedure 312 patients with CIN2+were identified;the missed diagnosis rate was only 7.69%,and the sensitivity was 92.31%,the specificity 82.02%;the positive predictive value was 70.91%,and the negative predictive value was95.74%.The AUC of colposcopy impression combined with high-grade abnormal cervical cytology(87.17%)was greater than that of colposcopy alone(86.45%)and high-grade abnormal cervical cytology alone(72.70%).Conclusion Combining colposcopy impression with high-grade abnormal cervical cytology can improve the ability to identify highgrade cervical lesions.

关 键 词：子宫颈脱落细胞学高级别异常 阴道镜 病理组织 子宫颈高级别上皮内病变 

分 类 号：R711.74[医药卫生—妇产科学]