阴道镜联合选择性液基细胞学检查对宫颈癌机会筛查人群的临床价值研究

Clinical value of colposcopy with selective thinprep cytology test for opportunistic cervical cancer screening

目的:探讨具有质控功能的电子阴道镜联合选择性液基细胞学检查对宫颈癌机会筛查的可行性及其成本效益。方法:回顾分析2014年6月至2016年12月门诊就诊的1 055例患者的阴道镜、液基薄层细胞检测(thinprep cytology test,TCT)、人乳头瘤病毒(human papillomavirus,HPV)及宫颈活检病理结果;以病理活检为金标准,比较电子阴道镜、阴道镜联合选择性TCT、HPV联合TCT对宫颈上皮内瘤变筛查的灵敏度、特异度、阳性预测值、阴性预测值、漏诊率、ROC曲线下面积及成本效益。结果:具有严格质控的阴道镜检查对≥宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅱ型病变筛查的特异度为96.9%,阳性预测值为84.2%,高于其他检测方式(P<0.05),筛查成本最低(P<0.05),而灵敏度为65.9%,漏诊率为34.1%,筛查敏感性低于其他检测方式(P<0.05)。阴道镜对Ⅰ型转化区筛查的灵敏度为88.4%,漏诊率为11.6%,筛查敏感性明显高于Ⅱ、Ⅲ型转化区(P<0.05)。阴道镜若联合选择性液基细胞学检查后对Ⅱ、Ⅲ型转化区灵敏度及漏诊率均有改善(P<0.05),整体灵敏度升高至81.5%,漏诊率由34.1%降低为18.5%(P<0.05)。结论:严格质控下的阴道镜联合选择性液基细胞学检查灵敏度高,漏诊率低,诊断成本低,适用于经济欠发达地区宫颈癌机会性筛查。

Objective:To explore the clinical value and cost-benefit value of colposcopy combined with selective thinprep cytology test (TCT) in opportunistic cervical cancer screening. Methods:Retrospective analysis was conducted among 1 055 patients undergoing colposcopy,TCT,human papillomavirus(HPV) and histopathological examination from June 2014 to December 2016. The final diag-nosis depended on the pathological results. The sensitivity,specificity,positive and negative predictive value,false negative rate,the area under ROC curve and cost-benefit value of colposcopy and colposcopy combined with TCT,TCT combined with HPV were compared. Results:For lesions≥cervical intraepithelial neoplasia(CIN)Ⅱ,the specificity,positive predictive value of colposcopy was 96.9% and 84.2%,higher than that of other methods,and the cost of screening was the lowest(P<0.05);the sensitivity and false neg-ative rate was 65.9% and 34.1%,the screening sensitivity was lower than that of other methods. In transformation zone(TZ)Ⅰ,the sensitivity and false negative rate was 88.4% and 11.6%,and the screening sensitivity was higher than that in type Ⅱ and Ⅲ TZ(P<0.05). When combined with selective TCT,the sensitivity and false negative rate could be improved(P<0.05). The total sensitivity could be raised to 81.5%,the false negative rate could be reduced to 18.5%(P<0.05). Conclusion:Colposcopy combined with selective liquid based cytology has high sensitivity and low false negative rate,and it has high screening sensitivity and low screening cost. It should be used for opportunistic cervical cancer screening in underdeveloped regions.