网络质控阴道镜在宫颈癌机会筛查中的临床价值

Clinical Value of Colposcopy with Networked Quality Control on Opportunistic Screening for Cervical Cancer

目的:探讨具有网络质控的阴道镜在宫颈癌机会筛查中的临床价值。方法:回顾分析2013年11月到2014年11月到重庆医科大学附属第二医院就诊的831例患者的具有网络质控的阴道镜、宫颈液基细胞(TCT)、人乳头瘤病毒(HPV)及宫颈活检病理检查结果;以病理检查为金标准,比较具有网络质控的阴道镜、TCT、HPV单独以及联合对宫颈病变筛查的灵敏度、特异度、阳性预测值、阴性预测值及ROC曲线下面积。结果:具有网络质控的阴道镜对≥CINⅡ病变检出的特异度、阳性预测值及ROC曲线下面积分别为96.30%、85.63%、0.874,明显高于TCT、HPV单独或联合检测(P<0.05);具有网络质控的阴道镜联合HPV检测的灵敏度、阴性预测值分别为98.28%及99.28%,明显高于其他方法单一或联合检测(P<0.05)。Ⅰ型宫颈转化区下阴道镜对≥CINⅡ病变检出的灵敏度、特异度、阳性预测值、阴性预测值及ROC曲线下面积分别为92.71%、98.67%、94.68%、98.15%、0.957,明显高于Ⅱ型及Ⅲ型宫颈转化区(P<0.05)。结论:具有网络质控的阴道镜可用于宫颈癌机会筛查;宫颈不同转化区类型对阴道镜诊断结果有一定影响,对Ⅱ型及Ⅲ型宫颈转化区需联合其他筛查手段。

Objective： To investigate the clinical value of colposcopy with networked quality control on opportunistic screening for cervical cancer. M ethods： The clinical data of 831 patients undergoing colposcopy with networked quality control,TCT,HPV and histopathological examination from November,2013 to November,2014 in the second affiliated hospital of chongqing medical university were retrospectively anaylzed. With pathological results as the gold standard,the sensitivity,specificity,positive and negative predictive value as well as the area under ROC curve of colposcopy with networked quality control,TCT,HPV exclusive or combined screening for cervical cancer were analyzed. Results： For lesions ≥CINⅡ,the specificity,the positive predictive value and the area under ROC curve of colposcopy with networked quality control were 96. 30% 、85. 63% and 0. 874,respectively,which were significantly higher than TCT,HPV exclusive or combined screening（ P〈0. 05）. The diagnosis sensitivity and the negative predictive value for lesions ≥CINⅡ were improved with the combination of colposcopy with networked quality control,TCT and HPV,the sensitivity and the negative predictive value of colposcopy with networked quality control combined with HPV were 98. 28% and 99. 28%,which were significantly higher than the other methods exclusive or combined screening（ P〈0. 05）. Different types of cervical transformation zone had some impact on the result of colposcopy. The sensitivity,the specificity,the positive and negative predictive value as well as the area under ROC curve of colposcopy for type Ⅰ cervical transformation zone were 92. 71% 、98. 67% 、94. 68% 、98. 15% 、0. 957,respectively,which were significantly higher than type Ⅱ and Ⅲ cervical transformation zone（ P〈0. 05）. Conclusions： Colposcopy with networked control could be used in opportunistic screening for cervical cancer. Different cervical transformation zone has a certain influence on colposcopy,for the type Ⅱ and type Ⅲ cervical transformation zone,other screening methods such as TCT and HPV should be used combined with colposcopy with networked control.