光学相干断层扫描用于宫颈病变早期诊断的临床价值  

Multi-center clinical study using optical coherence tomography for evaluation of cervical lesions in-vivo

作　　者：穆雪峰 张燕[1] 李琳[2] 陈克明[3] 张毅[4] 谷新 Mu Xuefeng;Zhang Yan;Li Lin(Department of Obstetrics and Gynecology,Renmin Hospital of Wuhan University,Wuhan 430060;Xiangyang Central Hospital,Xiangyang 441000)

机构地区：[1]武汉大学人民医院妇产科,武汉430060 [2]襄阳市中心医院,襄阳441000 [3]荆州市第一人民医院,荆州434000 [4]十堰市人民医院,十堰442000 [5]恩施土家族苗族自治州中心医院,恩施445000

出　　处：《现代妇产科进展》2025年第1期27-32,37,共7页Progress in Obstetrics and Gynecology

基　　金：湖北省重点研发计划项目(No:2022BCA010)。

摘　　要：目的:评估光学相干断层扫描(OCT)用于宫颈病变早期诊断的临床价值。方法:选取2023年2月至11月在湖北省5家三甲医院妇科门诊拟行阴道镜检查的1295例患者。患者先行OCT,后在阴道镜下行宫颈活检和(或)宫颈管搔刮。以组织学诊断为金标准,评估OCT单独或联合HPV检测对宫颈上皮内瘤变(CIN)2级及以上病变(CIN2+)/CIN3及以上病变(CIN3+)的诊断性能。结果:共检出122例CIN2、131例CIN3+。OCT诊断CIN2+/CIN3+的特异度、准确率分别为93.9%/88.2%、89.5%/87.6%,均显著高于HPV检测和TCT检查,差异有统计学意义(P<0.001)。OCT诊断CIN2+/CIN3+的灵敏度低于HPV检测(71.5%vs 95.7%、82.4%vs 95.4%,P<0.001)。OCT联合HPV检测与TCT联合HPV检测的灵敏度相似,但特异度、准确率、PPV、NPV均高于TCT联合HPV检测,差异均有统计学意义(P<0.05)。hrHPV感染者基于OCT分诊的阴道镜转诊率远低于基于TCT的转诊率(非16/18型hrHPV:14.6%vs 72.1%、hrHPV:20.9%vs 61.3%,P<0.001)。对于非16/18型hr HPV感染者,TCT异常的OCT阴性患者CIN3+风险为2.1%(<4%),而TCT正常的OCT阳性患者CIN3+风险为38.5%。结论:OCT单独或联合HPV检测对宫颈CIN2/CIN3+的早期筛查具有良好的诊断性能,OCT分诊可减少hr HPV感染患者的阴道镜转诊率。Objective:To evaluate the clinical value of optical coherence tomography(OCT)in the early diagnosis of cervical lesions.Methods:From February to November 2023,1295 women who visited the colposcopy in the gynecological outpatient department of 5 tertiary hospitals in Hubei Province were included in the study.OCT was performed before colposcopy,biopsy and/or endocervical curettage was then performed.To evaluate the diagnostic performance of OCT alone or in combination with HPV detection for cervical intraepithelial neoplasia(CIN)grade 2 and worse(CIN2+)/CIN3 and worse(CIN3+)with histological diagnosis as the gold standard.Results:122 women were diagnosed as CIN2,131 women were diagnosed as CIN3+lesions.The specificity and accuracy of OCT in the diagnosis of CIN2+/CIN3+were 93.9%/88.2%,89.5%/87.6%,respectively,which were significantly higher than those of HPV and TCT(P<0.001).The sensitivity of OCT diagnosis was lower than that of HPV detection(71.5%vs 95.7%,82.4%vs 95.4%,P<0.001).The sensitivity of OCT combined with HPV test and TCT combined with HPV test was similar,but the specificity,accuracy,PPV and NPV were all higher than that of TCT combined with HPV test,and the difference was statistically significant(P<0.05).For patients with hr HPV infection,the referral rate of colposcopy based on OCT triage was much lower than that based on TCT(non-16/18 hr HPV:14.6%vs 72.1%,hr HPV:20.9%vs 61.3%,P<0.001).For patients with non-16/18 hr HPV infection,the risk of CIN3+in OCT-negative patients with TCT abnormalities was 2.1%(<4%),and the risk of CIN3+in OCT-positive patients with normal TCT was 38.5%.Conclusion:OCT testing alone or in combination with HPV testing has good diagnostic performance for early screening of cervical CIN2/CIN3+,and OCT triage can reduce the rate of colposcopy referral in patients with hr HPV infection.

关 键 词：宫颈癌筛查 多中心 光学相干断层扫描 HPV TCT 准确性 

分 类 号：R737.33[医药卫生—肿瘤]