改良Reid阴道镜评分在CIN分级诊断中的应用价值

The Modified Reid's Colposcopic Index in CIN Detection and Grading

目的评价改良的Reid阴道镜评分系统(RCI)在宫颈上皮内瘤变(CIN)分级诊断中的应用价值。方法对宫颈液基薄层细胞学(TCT)筛查异常的482例患者行阴道镜检查,就异常图像的宫颈病变颜色、边界、异形血管及碘试验行改良的Reid阴道镜评分,初步判断病变分级。在可疑病变部位取多点病理活检。结果阴道镜下评分与组织病理学完全符合率为80.50%,能检测出CIN及浸润癌的敏感性为96.49%,特异性为82.07%,阳性预测值62.50%。0～2分组、3～4分组、5～8分组的诊断阳性预测值分别为28.00%、52.08%、92.86%。评分系统对CINⅠ/Ⅱ/Ⅲ的诊断敏感性分别为93.18%、70.59%、58.33%。6例浸润癌的评分均在3分以上。阴道镜RCI评分与组织病理学结果经Kappa一致性检验,其值为0.5209(P<0.05),存在一致性。结论改良RCI评分应用于CIN分级的半定量判断,可提高阴道镜诊断的准确性和客观性;有助于减少阴道镜下宫颈癌前病变,尤其是低级别CIN的漏诊率。

Objective To evaluate the value of the modified Reid＇s colposcopic index （RCI） in the detection of cervical lesions by comparison with multiple biopsies. Methods 482 patients with abnormal cytological results received colposcopic examinations were multiple biopsied and scored according to the modified Reid＇s colposcopy index. Results Comparing the score with biopsied result,the consensus rate was 80.50%.The sensitivity was 96.49% ,and the specificity was 82.07%. The positive predictive value of RCI was 62.50%. The positive predictive value of patients with 0- 2,3- 4 and 5- 8 points was 28.00% ,52.08% ,92.86% ,respectively. Sensitivity to CIN Ⅰ/Ⅱ/Ⅲetection is respectively 93.18%,70.59%,58.33%.Scores of 6 cases with invasive cancer were all above 3 points. There was an agreement between RCI and biopsied results（kappa value=0.5209,P〈0.05）. Conclusion The modified Reid colposcopic index（RCI）is valuable in the diagnosis of cervical lesions. It will decrease the missed diagnosis rate in patients with cervical dysplasia, especially low ~rade CIN.