宫颈管搔刮术联合阴道镜阴性象限活检在宫颈上皮内瘤变中的应用价值

The application value of cervical scraping combined with negative quadrant biopsy of colposcopy in high-grade cervical lesions

目的 分析宫颈管搔刮术(ECC)联合阴道镜阴性象限组织活检在宫颈上皮内瘤变中的应用价值。方法 选择浙江省舟山市妇女儿童医院2020年2月~2022年2月接诊的人乳头瘤病毒(HPV)、宫颈细胞学(TCT)检查异常的患者100例,均给予宫颈管搔刮术联合阴道镜阴性象限组织活检,将手术病理结果作为诊断金标准,比较阴道镜阴性象限组织活检、宫颈管搔刮术联合阴道镜阴性象限组织活检的诊断符合率、特异度、灵敏度、阳性预测值、阴性预测值,对两种方法与金标准行一致性检验。结果 宫颈管搔刮术联合阴道镜阴性象限组织活检与金标准的一致性92.00%(Kappa=0.871)高于阴道镜阴性象限组织活检与金标准的一致性74.00%(Kappa=0.658),差异有统计学意义(P<0.01)。宫颈管搔刮术联合阴道镜阴性象限组织活检诊断CINⅠ、CINⅡ、CINⅢ的特异度、灵敏度、诊断符合率、阴性预测值、阳性预测值均高于阴道镜阴性象限组织活检,差异有统计学意义(P<0.01)。结论 宫颈管搔刮术联合阴道镜阴性象限组织活检可提高宫颈上皮内瘤变诊断的灵敏度与特异度,与术后病理诊断结果符合率较高,应将其作为阴道镜的补充检查。

Objective Objective To analyze the application value of cervical curettage(ECC)combined with vaginal colposcopy negative quadrant tissue biopsy in high-grade intraepithelial neoplasia(HSIL)of the cervix.Method A total of 100 patients with abnormal human papillomavirus(HPV)and cervical cytology(TCT)tests admitted to Zhoushan Women and Children's Hospital in Zhejiang Province from February 2020 to February 2022 were selected.All patients underwent cervical scraping surgery combined with vaginal negative quadrant tissue biopsy.The surgical pathological results were used as the diagnostic gold standard for this study.The diagnostic accuracy,specificity,sensitivity,positive predictive value and negative predictive value of vaginal negative quadrant tissue biopsy and cervical scraping surgery combined with vaginal negative quadrant tissue biopsy were compared,and the consistency between the two methods and the gold standard was tested using Kappa.Results The consistency between cervical scraping surgery combined with colposcopy negative quadrant tissue biopsy and the gold standard was 92.00%(Kappa=0.871),which was higher than the consistency between colposcopy negative quadrant tissue biopsy and the gold standard was 74.00%(Kappa=0.658)(P<0.01).The specificity,sensitivity,diagnostic accuracy,negative predictive value,and positive predictive value of cervical scraping combined with colposcopy negative quadrant tissue biopsy in diagnosing CINI,CINII,and CINI were all higher than those of colposcopy negative quadrant tissue biopsy(P<0.01).Conclusion Cervical canal scraping combined with vaginal colposcopy negative quadrant tissue biopsy can improve the diagnostic sensitivity and specificity of high-grade cervical intraepithelial neoplasia,and has a high diagnostic accuracy with postoperative pathological diagnosis results.It should be used as a supplementary examination for colposcopy.