光电筛查系统与阴道镜检查宫颈病变的对照研究  

A comparative study of photoelectric screening system Truscreen and colposcopy in cervical lesions screening

作　　者：朱波 刘建华[1] 王瑾蔚 夏淑华 Zhu Bo;Liu Jianhua;Wang Jinwei;Xia Shuhua(Department of Gynecology and Obstetrics,Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200011;Department of Gynecology and Obstetrics,Huangpu Branch of Shanghai Ninth Peoples Hospital Afiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200001;Department of Gynecology and Obstetrics,Shanghai Fengcheng Hospital,Shanghai201400,P.R.China)

机构地区：[1]上海交通大学医学院附属第九人民医院妇产科,上海2000111 [2]上海交通大学医学院附属第九人民医院黄埔分院妇产科,上海200001 [3]上海奉城医院妇产科,上海201400

出　　处：《中国计划生育和妇产科》2022年第11期74-77,共4页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨宫颈癌光电筛查系统(truscreen,TS)对宫颈癌及癌前病变检查的临床价值。方法选取2017年9月至2021年4月就诊于上海交通大学医学院附属第九人民医院等三家医院,经液基细胞学检查(thinprepcytological test,TCT)和HPV检查后需行阴道镜检查的患者283例为研究对象,先行TS检查,再行阴道镜检查,均行宫颈活检。对照组织病理学检查结果,比较TS与阴道镜检查宫颈病变的临床效果。本研究中设定低级别鳞状上皮内病变(lowgrade squamous intraepitheliallesion,LSIL)、高级别鳞状上皮内病变(highgrade squamous intraepithelial lesion,HSIL)和浸润癌结果为阳性,其余病变为阴性。结果研究对象中25.1%(71/283)提示病理学结果为阳性。TS的敏感度为71.8%(51/71),特异度为72.6%(154/212),假阴性率为28.2%(20/71),假阳性率为27.4%(58/212),阳性预测值为46.8%(51/109),阴性预测值为88.5%(154/174),与病理的符合率为72.4%(205/283),Kappa值=0.378。阴道镜检查的敏感度为69.0%(49/71),特异度为62.3%(132/212),假阴性率为31.0%(22/71),假阳性率为37.7%(80/212),阳性预测值为38.0%(49/129),阴性预测值为85.7%(132/154),与病理的符合率为63.9%(181/283),Kappa值=0.246。TS的敏感度、阳性预测值、阴性预测值差异无统计学意义(P>0.05),TS的特异度及病理检查的符合率均明显高于阴道镜(P<0.05)。低级别病变组中TS与阴道镜的敏感度分别为60.4%、72.9%,差异无统计学意义(P>0.05);高级别病变组中TS敏感度95.7%显著高于与阴道镜60.9%。结论1.TS具有无创、简便、快捷等优点,诊断效果要优于阴道镜。2.TS在宫颈高级别病变的检查中更具有一定优势。因此,可作为宫颈癌早期检查的新方法进一步进行研究与应用。Objective To investigate the clinical value of Truscreen(TS) in the detection of cervical cancer and precancerous lesions.Methods From September 2017 to April 2021,283 patients who underwent colposcopy after thinprep cytological test(TCT) and HPV examination in three hospitals including the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were selected as the research objects.TS examination, colposcopy and cervical biopsy were performed.Compared with the results of histopathology, the clinical effects of TS and colposcopy on cervical lesions were compared.In this study, low grade squamous intraepithelial lesions(LSIL) and high grade squamous intraepithelial lesions(HSIL) and invasive carcinoma were positive, and the remaining lesions were negative.Results 25.1%(71/283) of the subjects showed positive pathological results.The sensitivity of TS was 71.8%(51/71),the specificity was 72.6%(154/212),the false-negative rate was 28.2%(20/71),the false-positive rate was 27.4%(58/212),the positive predictive value was 46.8%(51/109),and the negative predictive value was 88.5%(154/174).The coincidence rate with pathology was 72.4%(205/283),and Kappa value was 0.378.The sensitivity of colposcopy was 69.0%(49/71),the specificity was 62.3%(132/212),the false-negative rate was 31.0%(22/71),the false-positive rate was 37.7%(80/212),the positive predictive value was 38.0%(49/129),and the negative predictive value was 85.7%(132/154).The coincidence rate with pathology was 63.9%(181/283),and Kappa value was 0.246.There was no significant difference in sensitivity, positive predictive value and negative predictive value of TS(P>0.05),the specificity and coincidence rate of TS with pathological examination were significantly higher than those of colposcopy(P<0.05).In the low-grade lesion group, the sensitivity of TS and colposcopy was 60.4% and 72.9%,respectively, with no significant difference(P>0.05);In the high-grade lesion group, the sensitivity of TS was 95.7% significantly higher than that

关 键 词：光电筛查系统 阴道镜 宫颈癌检查 宫颈低级别鳞状上皮内病变 宫颈高级别鳞状上皮内病变 

分 类 号：R711.74[医药卫生—妇产科学]