计算机辅助阅片系统在宫颈癌筛查应用中的有效性观察

The effectiveness of ThinPrep imaging system in screening for cervical cancer

目的探讨计算机辅助阅片系统（Thin Prep imaging system，TIS）在宫颈癌筛查应用中的有效性。方法分别采用单纯人工阅片（Manual Screening，MS）和TIS辅助阅片对同一个宫颈细胞学检查标本进行初筛，结果不一致的由两名高年资的医生复核做出最终诊断。比较MS与TIS的诊断结果，计算ASC＋的检出率、假阴性率、假阳性率，阳性预测值、阴性预测值，敏感性和特异性。结果MS与TIS共同筛查925例，结果为ASC＋的MS75例（8．1％），TIS86例（9．3％）；假阴性MS23例（2．5％），TIS10例（1．1％）；假阳性MS15例（1．6％），TIS13例（1．4％）；阴性预测值MS97．3％，TIS98．8％；阳性预测值Ms72．3％，TIS88．0％；敏感性MS72．3％，TIS88．0％；特异性MS98．2％，TIS98．5％。结论初步数据表明，TIS敏感性好于MS，明显降低了假阴性率，而特异性没有受影响，在采纳新的技术后，有必要对医生进行适当的培训以适应新的筛查方法。

Objective To explore the effectiveness of ThinPrep imaging system （TIS） in screening for cervical cancer. Methods The same specimens of cervical cells were preliminarily screened by manual screening （MS） and TIS. The final diagnosis for the screened specimen with different results was made by two senior physicians.The results diagnosed by MS and TIS were compared with the final diagnosis to calculate the detection rate of ASC＋, false negative rate, false positive rate, positive predictive value, negative predictive value, sensitivity, and specificity. Results Of 925 screened specimens, 75 （8.1%） were ASC＋ positive by MS and 86 （9.3%） by TIS. The false negative rate was 23 （2.5%） in MS and 10 （1.1%） in TIS; the false positive rate was 15 （1.6%） and 13 （1.4%）; the negative predictive value was 97.3% and 98.8%; the positive predictive value was 72.3% and 88.0%; the sensitivity was 72.3% and 88.0%; and the specificity was 98.2% and 98.5%, respectively. Conclusions The preliminary data suggest that the sensitivity for TIS was much better than that for MS. TIS significantly reduces the false negative rate but has no effect on the specificity. Doctors need to be properly trained to adapt the new screening method after application of new technology.