宫颈上皮内瘤变的阴道镜图像特征与意义

The Feature and Significance of Colposcopy Images in the Diagnosis of Cervical Intraepithelial Neoplasia

目的：探讨宫颈上皮内瘤变（CIN）的阴道镜图像特征与意义，评价阴道镜图像特征对CIN的诊断价值。方法：对2004年3月至2006年7月进行阴道镜检查的患者629例，行镜下定位取活组织送病理检查。结果：CIN组醋酸白色上皮、点状血管、镶嵌、腺口白环发生率均显著高于非CIN组，高级别CIN组镶嵌、点状血管的发生率显著高于低级别组。根据阴道镜拟诊和组织病理学结果进行对照。醋酸白色上皮或白环加点状血管或镶嵌对CIN诊断的符合率为84．8％。醋酸白色上皮或白环加点状血管加镶嵌三联征图像对CINⅢ诊断的敏感性为66．7％，特异性为94．6％，阴性预测值为99．1％；对CINⅠ～Ⅲ诊断的特异性为98．9％，阳性预测值为89．4％，阴性预测值为74．1％。结论：阴道镜是辅助诊断CIN的有效方法，醋酸白色上皮和白环对CIN的诊断有重要价值，如与点状血管和（或）镶嵌同时存在则特异性增高。初次阴道镜检可疑时应进行常期活检。

Objective： To investigate the character and significance of colposcopy images in the diagnosis of cervical intraepithelial neoplasia （CIN）, and to evaluate the value of colposcopy images in the diagnosis of CIN. Methods： Colposcopic inspections and biopsies were performed on 629 patients between March 2004 and July 2006 in our hospital. Their clii4tcal-pathological data were reviewed. Results：The incidence rate of acetowhite epithelium, puncta vasculosa, mosaic, and white cuffed gland opening （WCGO） in the cases of CIN was significantly higher than that of non-CIN. The accuracy, specificity, positive predictive value （ PPV）, and negative predictive value （NPV） of colposcopy with acetowhilt epithelium or puncta vasculosa in evaluation of CIN Ⅲ were 84.8%, 98.9%, 89.4%, and 74.1%, respectively; The sensitivity, specificity, and NPV of the triple signs in evaluation of CIN Ⅲ were 66.7%, 94.6% and 99.1%, respectively.Corlclusions：Colposcopy is an effective assistant method for diagnosing CIN.Acetowhite epithelium and WCGO are important for diagnosing CIN under colposcopy; In the cases with punctuation and/or mosaic, the specificity increased significantly; The initial colposcopy should include routine cervical biopsies.