细胞学及阴道镜检查对宫颈病变的诊断价值

Value of cervical cytologic tests and colposcopy in diagnosis of cervical lesions

目的评价细胞学及阴道镜检查对宫颈病变的诊断价值。方法以宫颈环型电切术(LEEP)后病理诊断为标准,对照分析巴氏涂片、液基薄层细胞检测(TCT)、阴道镜、细胞学联合阴道镜检查对400例患者宫颈病变的筛查结果。结果巴氏涂片灵敏度64.9%,特异度85.4%,假阴性率35.1%,假阳性率14.6%;TCT灵敏度77.8%,特异度80.7%,假阴性率22.2%,假阳性率19.3%;阴道镜灵敏度92.5%,特异度74.3%,假阴性率7.5%,假阳性率25.7%;阴道镜诊断不足19例(8.2%),诊断过度54例(23.2%);细胞学联合阴道镜灵敏度92.9%,特异度64.1%,假阴性率7.1%,假阳性率35.9%。巴氏涂片与TCT的检出率比较,差异无统计学意义(P>0.05);阴道镜和细胞学联合阴道镜检查的检出率明显高于细胞学检查(P<0.05)。结论细胞学联合阴道镜检查是较为理想的宫颈病变筛查方法,阴道镜诊断宫颈病变仍存在一定的漏诊率,尚无法代替LEEP。

Objective To evaluate the diagnostic value of cervical cytology and colposcopy in the diagnosis of cervical lesions. Methods The results of Pap smear, ThinPrep cytologic test （TCT） , colposcopy and combined examination of cytology and colposcopy were determined according to the pathological outcomes of loop electrosurgical excision procedure （LEEP） in 400 samples. Results The sensitivity, specificity, false-negative rate and false-positive rate of Pap smear were 64.9% , 85.4% , 35.1% ,and 14.6% , respectively, and those of TCT were 77.8% , 80.7% , 22.2% and 19.3% , respectively, colposcopy 92.5% , 74.3% , 7.5% and 25.7% , respectively, and combined examination of cytology and colposcopy 92.9% , 64.1% , 7.1% and 35.9% , respectively. The underdiagnosis rate and overdiagnosis rate of colposcopy were 8.2% （ n = 19） and 23.2% （ n = 54） , respectively. There was no significant difference in the detection rate between Pap smear and TCT（P 〉0.05） , and the detection rate of colposcopy and combined examination of cytology and colposcopy was significantly higher than that of cytologic examination （ P 〈 0.05）. Conclusion The combination of cytology and colposcopy may be a most effective method in screening of cervical lesions. There exists certain rate of missed diagnosis for colposcopy, and it can not take place of cervical LEEP.