实时光电探测系统联合巴氏涂片在宫颈癌筛查中的作用

Application of real-time photoelectric detection system combined with the papanicolaou smear in the screening of cervical cancer

目的探讨实时光电探测系统（Ts）联合巴氏涂片（Pap）在宫颈癌筛查中的临床意义。方法对698例患者依次进行TS、Pap，以阴道镜和病理学检查为金标准，比较两种方法及联合方法的灵敏度、特异度和应用受试者工作特征曲线（ROC）的曲线下面积，并比较不同方法对宫颈上皮样瘤样病变II（CINII）及以上病变的漏诊率。结果（1）Pap、TS、TS联合Pap的灵敏度分别为33．4％、73．3％、83．7％，特异度分别为96．1％、77．9％和73．3％。（2）ROC曲线下面积，TS与Pap、TS联合Pap与Pap检测比较，差异有统计学意义。CINII以上漏诊，TS为8例（漏诊率19．0％），Pap为14例（漏诊率33．3％），而TS联合Pap为2例（漏诊率4．8％），TS联合Pap漏诊率低于TS和Pap，差异有统计学意义。结论本研究中，鸭的诊断效果评价优于Pap，TS联合Pap可以提高宫颈癌的筛查效果，减少宫颈CINII及以上病变的漏诊率，可考虑作为宫颈癌的早期筛查方法。

Objective To examine the clinical value of truscreen screening system （TS） compared with Papsmear test （Pap） in the screening of cervical lesion. Methods A total of 698 cases of patients were screened by TS and Pap. Results were compared with pathology and colposcopy results, which were used as golden standards. The sensitivity, specificity, and the area of under ROC of each method and their combination （ parallel test） were compared. The rate of missed diagnosis of the cervical lesions ≥ CINII were compared. Results The sensitivity of TS, Pap, and Pap parallel with ＇IS was 33.4 % , 73.3 %, and 83.7 %, respectively, and the specificity was 96. 1%, 77.9 %, and 73.3 % , respectively. With regard to the areas of under ROC, there were significant differences between TS and Pap, TS parallel with Pap, and Pap. Eight CINII lesions （ 19.0 % ） were missed by TS, fourteen CINII lesions （ 33. 3 % ） were missed by Pap, and two CINII lesions （4. 8 % ） were missed by ＇IS parallel with Pap. Conclusion This study showed the TS, as well as TS parallel with Pap are better than conventional Pap. TS parallel with Pap could reduce the rate of missed diagnosis of high cervical lesion, and therefore may have clinical implications in early screening of cervical carcinoma.