新型固有荧光灰阶图像诊断技术与阴道镜诊断子宫颈疾病的比较研究

Comparative study on autofluorescent gray-scale image diagnostic technique and colposcopy in the diagnosis of cervical lesions

目的探讨新型固有荧光灰阶图像诊断技术在子宫颈癌前病变及早期子宫颈癌中的应用价值。方法对2018年1月至2019年6月在上海交通大学医学院附属第九人民医院妇科门诊进行阴道镜检查的2178例患者同时进行固有荧光子宫颈病变图像诊断仪和阴道镜检查,收集需要进行活检的264例子宫颈病变患者作为研究对象,通过与病理组织学检查结果对比,比较固有荧光子宫颈病变图像诊断仪与阴道镜检查和发现子宫颈病变的灵敏度、特异度、诊断符合率,并绘制ROC曲线,以评估新型固有荧光灰阶图像诊断技术诊断子宫颈病变的价值。结果264例患者中,病理组织学诊断显示子宫颈癌11例、子宫颈高级别鳞状上皮内病变(HSIL)34例、子宫颈低级别鳞状上皮内病变(LSIL)124例、其他病变95例。固有荧光子宫颈病变图像诊断仪拟诊子宫颈癌10例,HSIL 32例,LSIL 120例,其他102例;阴道镜拟诊子宫颈癌10例,HSIL 34例,LSIL 166例,其他54例。我们设定拟诊断为HSIL及子宫颈癌为阳性结果,拟诊为LSIL及其他病变为阴性结果,固有荧光子宫颈病变图像诊断仪和阴道镜检测阳性结果的灵敏度分别为75.6%和77.8%,特异度为96.3%和95.9%,ROC曲线下面积分别为0.860±0.039和0.868±0.038。两种技术的上述有效性指标差异均无统计学意义(P<0.05)。结论固有荧光灰阶图像诊断技术诊断子宫颈高级别病变及子宫颈癌的临床价值与阴道镜相当,固有荧光灰阶图像诊断技术操作方便、检查时间短、稳定性较好,易于掌握和普及,是一种有效的子宫颈疾病检查和筛查技术,有必要进一步进行研究和应用。

Objective To investigate the clinical value of autofluorescent gray-scale image(AFGI)diagnostic technique in the detection of precancerous lesions and early cancer of uterine cervix.Methods From Jan 2018 to June 2019,2718 patients who received colposcopy were simultaneously examined by AFGI diagnostic technique in Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University,School of Medicine.A total of 264 patients with cervical lesions,who were considered to need biopsies by either of the two techniques,were enrolled as subjects.By comparison with the histopathological results,the sensitivity,specificity and diagnostic coincidence rate of AFGI diagnostic technique and colposcopy were compared,and ROC curve drawn,so as to evaluate the clinical value of AFGI diagnostic technique in diagnosis of cervical lesions.Results Among the 264 cases,the histopathological diagnosis showed 11 cases of cervical cancer,34 cases of high-grade cervical squamous intraepithelial lesion(HSIL),124 cases of low-grade squamous intraepithelial lesion(LSIL)and 95 cases of other lesions.Ten cases of cervical cancer,32 cases of HSIL,120 cases of LSIL and 102 cases of others were found by AFGI diagnostic technique.Ten cases of cervical cancer,34 cases of HSIL,166 cases of LSIL,and 54 cases of others lesions were found by colposcopy.With the assumption that HSIL and cervical cancer were positive result,and LSIL and other lesions were negative one,the sensitivity of the positive results of AFGI diagnostic technique and colposcopy was 75.6%and 77.8%,respectively,the specificity 96.3%and 95.9%,and the area under the ROC curve was 0.860±0.039 and 0.868±0.038.There was no significant difference in the above effectiveness indicators between the two techniques(P<0.05).Conclusion AFGI diagnostic technique is as effective as colposcopy in detection of cervical lesions,and moreover,it is easy to operate and learn,with shorter time of inspection and stable results.It is be an effective technique for cervical lesion detection and screening,and therefore needs further studying and clinical application.