宫颈癌筛查“三阶梯”方案的效果观察

A CROSS SECTIONAL SURVEY ON 704 CASES ABOUT THE EFFECT OF THREE-STEP PROTOCOL FOR CERVICAL CANCER SCREENING

目的：观察宫颈癌筛查＂三阶梯＂方案在我院妇科阴道镜门诊就诊病人中的应用价值。方法：选取2012-10~2014-08就诊于解放军总医院妇科阴道镜门诊的连续病人704例,以组织病理学为诊断金标准,计算液基细胞学、高危型人乳头状病毒（Human popilloma virus,HPV）检测及阴道镜结果的诊断指标。结果：随年龄增加,TCT、Hr-HPV、阴道镜及病理阳性率有升高趋势,TCT和阴道镜统计学检验有显著性差异。TCT灵敏度90.24%,特异度17.55%,诊断符合率42.18%,Kappa=0.049;HPV灵敏度95.11%,特异度21.28%,诊断符合率55.62%,Kappa=0.155;阴道镜灵敏度83.84%,特异度75.27%,诊断符合率79.26%,Kappa=0.587。结论：宫颈癌筛查＂三阶梯＂方案可以有效地发现宫颈病变的高危人群,但由于细胞学检查和HPV检测的特异度较低,使阴道镜门诊存在过度转诊的现象,阴道镜的诊断价值较高,是三阶梯方案中不可缺少的重要部分。

Objective： To observe the effect of three- step protocol for cervical cancer screening in the colposcopy clinics of the department of gynecology. Methods： 704 consecutive patients in the colposcopy clinics of the department of gynecology,PLA General Hospital,from October 2012 to August2014. Evaluate the diagnostic index calculation of liquid based cytology,colposcopy and high- risk HPV detection results by histopathology as the gold standard for diagnosis. Results： TCT,Hr- HPV,colposcopy and pathologic positive rate had a rising trend with the increase of age. The results of TCT and colposcopy were statistically significant difference. TCT sensitivity of 90. 24%,specificity of17. 55%,diagnosis rate 42. 18%,Kappa = 0. 049,HPV sensitivity of 95. 11%,specificity of 21. 28%,diagnosis rate 55. 62%,Kappa = 0. 155,colposcopy sensitivity 83. 84%,specificity 75. 27%,diagnosis rate 79. 26%,Kappa = 0. 587. Conclusion： The three- step protocol for cervical cancer screening can effectively detect the high- risk population of cervical lesions,however,there is over referral to colposcopy clinics because of low specificity of TCT and HPV testing. Colposcopy has higher diagnostic value and plays the irreplaceable role in this protocol.