摘要
目的评价阴道镜下四象限活检在宫颈癌前病变筛查中的价值。方法利用1999年山西省襄垣县开展的1997例妇女的宫颈癌筛查横断面研究数据,比较阴道镜诊断宫颈高度鳞状上皮及以上病变(HSIL+)的敏感度、特异度和准确率等,同时比较阴道镜下四象限点活检与阴道镜下可疑病变活检病理结果。结果1997例筛查者中,病理诊断阴性1784例(89.3%),低度鳞状上皮内病变(LSIL)127例(6.4%),HSIL74例(3.7%),鳞状细胞癌(SCC)12例(0.6%)。阴道镜检查为阴性1478例(74.O%);阴道镜检查为阳性519例(26.0%),其中LSIL463例(23.2%),HSIL41例(2.1%),可疑癌15例(0.8%)。阴道镜检查的阳性率为26.0%(519/1997),与病理诊断结果的一致率为73.8%。以病理诊断为金标准,阴道镜检查发现HSIL+的敏感度为81.4%,特异度为76.5%。88例人乳头瘤病毒(HPV)阳性、液基细胞学(LBC)诊断未明确意义的非典型鳞状上皮细胞(ASC—US)及以上病变、阴道镜阴性患者中,病理诊断HSIL14例(15.9%),LSIL29例(33.0%);116例HPV阳性、LBC正常、阴道镜阴性患者中,病理诊断HSIL2例(1.7%),LSIL6例(5.2%)。两组患者的HSIL和LSIL检出率差异均有统计学意义(均P〈0.001)。阴道镜阴性的筛查者中,四象限活检对HSIL和LSIL病变的检出率分别为1.1%和4.7%。阴道镜检查结果异常519例,阴道镜下可疑病变活检与四象限活检诊断结果不一致19例,一致500例,符合率为96.3%。与四象限活检比较,若仅以阴道镜下异常象限进行指示性活检,则漏诊14.8%(19/128)的宫颈病变,其中漏诊8.6%(5/58)的HSIL,漏诊24.1%(14/58)的LSIL。结论阴道镜下四象限活检能发现更多的宫颈病变,准确性高。作为宫颈癌前病变筛查的重要手段,阴道镜下四象限活检可提高宫颈癌前病变的检出率。
Objective To evaluate the value of colposcopical 4-quadrant biopsies for detecting precancerous lesion in cervical cancer screening. Methods We used the data of a cross-sectional screening study in 1999, in which 1 997 women received cervical cancer screening in Xiang Yuan County, Shanxi province. The sensitivity, specificity and accuracy of both 4-quadrant biopsy and eolposeopy directed biopsy to detect high-grade or more severe squamous intraepithelial lesions (HSIL^+) were calculated. Results 1 784(89. 3%) women who received 4-quadrant biopsies and endocervical curettage were negative. 127 (6.4%) women were diagnosed as LSIL, 74(3.7%) women as HSIL and 12(0.6%) cases of squamous cell carcinoma. 1 478(74. 0%) women who received biopsies in the sites of abnormal lesions were negative, 463 (23.2%) cases of LSIL, 41(2.1%) cases of HSIL, 15(0.8%) cases of squamous cell carcinoma. The positive rate was 26.0% (519/1 997) for colposcopy, and the coincidence rate was 73.7% with pathological diagnosis. Sensitivity and specificity were 81.4% and 76.5% of colposcopy for HSIL^+. In total of 519 women were found to be with any abnormal colposcopic appearance. The consistency rate between 4-quadrant biopsies and suspicious lesion- directed biopsies was 96.3%. By suspicious lesion-directed biopsy alone, 14.8% cervical lesions were missdiagnosed, of which 8.6%(5/58) cases of total HSIL and 24.1% (14/58) cases of all LSIL. Conclusions 4- quadrant biopsy can detect more HSIL^+ lesions and is more accurate than suspicious lesion biopsy alone. As an important triage technique to detect cervical precancerous lesions, it can improve the detection rate of HSIL^+ lesions in cervical cancer screening.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2015年第11期875-879,共5页
Chinese Journal of Oncology
关键词
宫颈疾病
宫颈肿瘤
阴道镜检查
普查
诊断
Uterine cervical diseases
Uterine cervical neoplasms
Colposcopy
Mass screening
Diagnosis