阴道镜联合液基细胞学筛查宫颈病变的诊断价值

Clinical value of colposcopy combined with liquid-based cytology in diagnosis of cervical lesions

目的探讨阴道镜联合液基细胞学筛查宫颈病变的诊断价值。方法选取在江苏省省级机关医院行宫颈病变筛查的女性376例,对其行阴道镜联合液基细胞学检查,将检查结果与病理检查结果进行对比分析。结果阴道镜检查结果发现,正常或炎症203例,阳性预测值为93.5%;宫颈上皮内瘤变(CIN)Ⅰ82例,阳性预测值为83.7%;CINⅡ34例,阳性预测值为82.9%;CINⅢ13例,阳性预测值为86.7%;浸润癌5例,阳性预测值为100.0%。液基细胞学诊断结果显示,正常范围(WNL)200例,阳性预测值为92.2%;非典型鳞状细胞(ASCUS)81例,阳性预测值为81.0%;低级别鳞状上皮内病变(LSIL)30例,阳性预测值为81.1%;高级别鳞状上皮内病变(HSIL)15例,阳性预测值为93.8%;鳞状细胞癌(SCC)6例,阳性预测值为100.0%。以病理诊断为金标准,阴道镜阳性预测值为89.6%,液基细胞学阳性预测值为88.3%;阴道镜联合液基细胞学阳性预测值为97.1%,明显高于两者单独检查的阳性预测值,差异有统计学意义(x^2值分别为16.797、21.362,均P<0.05)。结论阴道镜联合液基细胞学检查可提高宫颈病变筛查的阳性预测值。

Objective To investigate the clinical value of colposcopy combined with liquid-based cytology in diagnosis of cervical lesions. Methods In Jiangsu Provincial Authority Hospital 376 women performing cervical lesion screening were chosen, and they were examined with colposcopy and liquid-based cytology examination. The final results were analyzed and compared with pathological results. Results Colposcopy showed that 203 cases were normal or with inflammation, and the positive predictive rate was 93.5%. There were 82, 34, 13 and 5 cases with CIN I , CIN Ⅱ , CIN Ⅲ and invasive cancer, respectively, and the positive predictive rate was 83.7%, 82.9%, 86.7% and 100.0%, respectively. Cytology results showed that 200 cases were WNL and the positive predictive rate was 92.2%. There were 81, 30, 15 and 6 cases of ASCUS, LSIL, HSIL and SCC, respectively, and the positive predictive rate was 81.0%, 81.1% ,93.8% and 100.0% , respectively. With pathological diagnosis as gold standard, the positive predictive rate of eolposeopy, liquid-based cytology, and eoiposcopy combined with liquid-based cytology was 89.6% , 88.3% and 97.1% , respectively. That of combined examination was obviously higher than two separate examinations, and the difference was significant （X2 value was 16. 797 and 21. 362, respectively, both P 〈 0.05 ）. Conclusion The combination of eolposcopy and liquid-based cytology can improve the positive predictive rate of cervical