R-way系统对宫颈病变的诊断价值及影响因素分析

Diagnostic value and influencing factors of R-way system for cervical lesions

目的探讨R-way系统对宫颈高级别病变/宫颈癌(HSIL+)的诊断价值及影响因素。方法回顾性分析行阴道镜检查和宫颈活检的987例患者临床资料。以宫颈组织病理学诊断为金标准,分析R-way系统的阴道镜诊断结果与宫颈组织病理学诊断的一致性,分析R-way系统对不同等级宫颈病变的诊断效能及对HSIL+诊断不足的危险因素。结果R-way系统阴道镜诊断和宫颈组织病理学诊断在689例患者(69.81%)中完全匹配,对186例患者诊断过度(18.84%),90例诊断不足(9.12%),32例(18.82%,32/170)HSIL+诊断不足。不同等级病变的阴道镜诊断与宫颈组织病理学诊断一致性差异均无统计学意义(均P<0.05),R-way系统诊断HSIL+的AUC、Youden指数、灵敏度、特异度、阳性预测值和阴性预测值分别为0.793(95%CI:0.755~0.831)、0.587(95%CI:0.521~0.652)、0.812(95%CI:0.753~0.871)、0.775(95%CI:0.746~0.803)、0.829(95%CI:0.775~0.883)、0.952(95%CI:0.936~0.968),均高于低级别鳞状上皮内病变。绝经后、III型转化区及单点活检是影响R-way系统对HSIL+诊断不足的独立危险因素(均P<0.05)。结论R-way系统对HSIL+有较高的诊断价值,绝经后、III型转化区的患者必要时行多点活检及宫颈管搔刮术,有助于降低漏诊率。

Objective To explore the diagnostic value and influencing factors of R-way system in cervical high-grade squamous intraepithelial lesion/cervical squamous cell carcinoma(HSIL+).Methods The clinical data of 987 patients undergoing colposcopy and cervical biopsy were retrospectively analyzed.Using cervical histopathological diagnosis as the gold standard,the consistency of the colposcopy diagnosis in R-way system and cervical histopathological diagnosis was analyzed,the diagnostic efficacy of the R-way system for different grades of cervical lesions and the risk factors for underdiagnosis of HSIL+were analyzed.Results The R-way system colposcopy diagnosis was completely consistent with cervical histopathology diagnosis in 689 patients(69.81%),overdiagnosed in 186 patients(18.84%),and underdiagnosed in 90 cases(9.12%),and 32 cases(18.82%)were underdiagnosed by HSIL+.There was no statistically significant difference in the consistency of colposcopic diagnosis with cervical histopathological diagnosis among different grades of lesions(P<0.05).The ROC-AUC,Youden index,sensitivity,specificity,positive predictive value and negative predictive value of HSIL+diagnosis by R-way were 0.793(95%CI:0.755-0.831),0.587(95%CI:0.521-0.652),0.812(95%CI:0.753-0.871),0.775(95%CI:0.746-0.803),0.829(95%CI:0.775-0.883),0.952(95%CI:0.936-0.968),respectively.Post-menopause,type III transformation zone and single-point biopsy were independent risk factors for underdiagnosis of HSIL+by the R-way system(all P<0.05).Conclusion The R-way system has a high diagnostic value for HSIL+.For postmenopausal and type III patients,multi-point biopsy and cervical scraping if necessary can help to reduce the rate of missed diagnosis.