临床阴道镜评分体系诊断宫颈鳞状上皮内病变的临床意义

Study on the clinical significance of clinical colposcopy scoring system in diagnosis of cervical squamous intraepithelial lesions

目的:探究临床阴道镜评分体系(CCI)在诊断宫颈鳞状上皮内病变中的临床意义。方法:选取符合转诊阴道镜指征的患者209例,分别应用CCI和Reid阴道镜评分体系(RCI)对阴道镜图像进行回顾性评价,得出阴道镜诊断结果。与组织病理学诊断结果进行比较,并对二者一致性和有效性进行评价。结果:RCI与组织病理学比较,一致率为66.99%,Kappa值为0.525,差异有统计学意义(P<0.05)。CCI与组织病理学诊断比较:一致率为84.21%,Kappa值为0.768,差异有统计学意义(P<0.05)。两种评分体系比较,差异有统计学意义(P<0.05),并具有良好一致性。应用CCI诊断高度鳞状上皮内病变(HSIL)及以上病变的灵敏度、诊断低度鳞状上皮内病变(LSIL)及以上病变和诊断慢性炎症的特异度较RCI高。结论:在诊断宫颈鳞状上皮内病变的能力上,CCI更优,诊断可重复性更高,在临床上实用性和可行性更强,更有利于临床上对宫颈病变的分级管理。

Objective:To explore the clinical significance of clinical colposcopy scoring system in diagnosis of cervical squamous intraepithelial lesions.Methods:209 patients who conformed with the indication for referral colposcopy were enrolled,the clinical colposcopy scoring system and Reid colposcopy scoring system were used to retrospectively evaluate colposcopy images,the results of diagnosis of colposcopy were obtained.Compared with histopathological findings and evaluated their consistency and effectiveness.Results:Reid colposcopy scoring system and histopathological diagnosis was compared,the consistent rate was66.99% and the Kappa value was 0.525,the difference was statistically significant(P<0.05).Clinical colposcopy scoring system and histopathological diagnosis was compared,the consistent rate was 84.21% and the Kappa value was 0.768,the difference was statistically significant(P<0.05).The two scoring systems was compared,the difference was statistically significant(P<0.05),they also had good consistency.The clinical colposcopy scoring system for diagnosis of HSIL and above lesions had higher sensitivity,the diagnosis of LSIL and above lesions and the diagnosis of chronic inflammation by clinical colposcopy scoring system were more specific than the Reid colposcopy scoring system.Conclusion:The clinical colposcopy scoring system is better in diagnosing cervical squamous intraepithelial lesions,the diagnosis is more repeatable and the clinical utility and feasibility are stronger.It is more conducive to clinical grading management of cervical lesions.