两种宫颈癌前病变诊断方法的评价

Comparison of the Diagnostic Accuracy Between Two Diagnostic Methods in Patients with Cervical Intraepithelial Neoplasia

目的 评价和比较阴道镜下多点活检和诊断性锥切诊断宫颈癌前病变 (CervicalIntraepithelialNeoplasia ,CIN )的价值。 方法 电子检索MEDLINE、CochraneLibrary( 2 0 0 3第 4期 )、中国生物医学文献数据库、中国生物医学期刊文献数据库、中国学术期刊全文数据库和中文科技期刊全文数据库 ,截止时间均为2 0 0 4年 3月。手检 1970年～ 2 0 0 3年的相关国内外杂志及未发表资料。纳入对阴道镜下多点活检或锥切诊断CIN的准确性与治疗性锥切和 /或全切术后的病理诊断 (金标准 )进行比较、且有分层对应数据的已发表和未发表的研究 ;其观察对象为临床疑诊宫颈癌前病变的患者。对纳入研究的质量进行评价 ,运用Cochrane协作网诊断与筛查小组推荐的SROC曲线法 ,以敏感度、特异度、准确度、阴性和阳性预测值、似然比等指标行Meta分析。结果 2 6篇文献符合纳入标准 ,共 3376例 (各研究的例数从 2例～ 6 0 4例 )。阴道镜下多点活检与诊断性锥切对CIN的诊断准确性在敏感性分析前后不一致。阴道镜下多点活检敏感度和特异度均为0 76 ,诊断性锥切的敏感度和特异度均为 0 83,阴道镜下活检诊断准确性明显低于锥切 (P <0 0 0 1)。而敏感性分析结果为 :阴道镜下多点活检敏感度和特异度均为 0 84 ;诊断性锥切的敏感度和?

Objective To compare and evaluate the sensitivity, specificity, accuracy, negative and positive predictive values, negative and positive likelihood ratios of colposcopically directed biopsy and diagnostic cone biopsy in patients with cervical intraepithelial neoplasia. Methods We searched PubMed, CBMdisc, CMCC, CNKI, and VIP to March 2004, and Cochrane Library(Issue 4, 2003). Related journals published from 1970 to 2003 and unpublished papers were hansearched. Diagnostic studies which employed colposcopically directed biopsy or diagnostic cone biopsy and compared with golden standard (pathological diagnosis of specimens obtained through therapeutic conization or hysterectomy) were included and meta-analysis was performed. Participants were clinically suspected of pre-cancerous cervical lesions. Quality of studies was assessed, and SROC curve by Diagnostic and Screening Group of the Cochrane Collaboration was used to perform meta-analysis. Parameters were sensitivity, specificity, accuracy, predictive values, and likelihood ratio.Results Twenty six studies (3 376 patients ranging from 2 to 604 patients/per study) met the inclusion criteria. The quality of studies was generally poor.Before sensitivity analysis, superiority of diagnostic cone biopsy ( sensitivity and specificity: 0.83) was shown over colposcopically directed biopsy ( sensitivity and specificity: 0.76 ) (TB3<0.001); while after sensitivity analysis the results reversed (sensitivity of diagnostic cone biopsy was 0.58 and its specificity was 0.61; sensitivity and specificity of colposcopically directed biopsy increased to 0.84 ) (3<0.001).Conclusions No definite conclusion can be drawn as to which method is superior. To make further analysis, more studies with high quality are needed.