复方醋酸染色联合阴道镜法在宫颈癌前病变筛查中的价值研究

Study on the value of compound acetic acid staining combined with colposcopy in the screening of cervical precancerous lesions

目的评估复方醋酸染色(VIA)联合阴道镜法在宫颈癌前病变筛查中的价值。方法2017年1月至2020年12月期间在海军军医大学第二附属医院宫颈门诊行宫颈癌筛查的妇女中,选择412例进行VIA、阴道镜、宫颈液基细胞学(TCT)和人乳头瘤状病毒(HPV)检查,病理结果作为金标准。结果筛查412例患者,经病理确诊为宫颈癌患者12例(排除在研究外),宫颈鳞状上皮内中度瘤变(CINⅡ级)44例,宫颈鳞状上皮内重度瘤变(CINⅢ级)80例。VIA联合阴道镜筛查出CINⅡ和CINⅢ的敏感性、特异性、阳性预测值、阴性预测值、约登指数和受试者工作特征曲线(ROC)下面积分别为90.3%,64.9%,53.6%,93.7%,0.55,0.776。TCT联合HPV筛查CINⅡ和CINⅢ的敏感性、特异性、阳性预测值、阴性预测值、约登指数和ROC曲线下面积分别为89.8%,74.5%,70.3%,85.6%,0.53,0.765。结论VIA联合阴道镜用于宫颈癌前病变筛查的敏感性、特异性,诊断效能不低于TCT联合HPV。由于操作简单,成本低廉,可于人群中推广。

Objective To assess the value of compound acetic acid staining(VIA)combined with colposcopy in cervical pre-cancer screening.Methods Of the females who underwent cervical cancer screening at the cervical outpatient between January 2017 and December 2020,412 patients were randomly selected for VIA,colposcopy,cervical fluid-based cytology(TCT)and human papil-lomavirus(HPV)detection,with pathological findings as the gold standards.Results Of the 412 patients screened,12 patients were confirmed to have cervical cancer with pathology(excluded from the study),44 patients were diagnosed to have cervical squamous in-traepithelial neoplasia(CIN II),and 80 patients were confirmed to have cervical squamous intraepithelial neoplasia(CIN III).The sensitivity,specificity,positive predictive value,negative predictive value,Jorden index,and the area under the operating character-istic curve(ROC)were respectively 90.3%,64.9%,53.6%,93.7%,0.55,and 0.776.The sensitivity,specificity,positive pre-dictive value,negative predictive value,Yorden index,and area under the ROC curve of TCT combined with HPV screening for CIN II and CIN III were respectively 89.8%,74.5%,70.3%,85.6%,0.53 and 0.765.Conclusion The sensitivity,specificity,and high diagnostic efficacy of VIA combined with colposcopy for cervical precancerous lesion screening were no lower than TCT combined with HPV.Having the advantages of easy operation and low cost,it is worth further promotion.