电子阴道镜和光学阴道镜在宫颈早期病变诊断中的比较研究

A comparitive study of digital colposcope and optical colposcope in the diagnosis of early lesions of uterine cervix

目的 评价国产电子阴道镜 (SLC 2 0 0 0 )检测系统对宫颈早期病变诊断的临床应用价值。方法 在山西省襄垣县宫颈癌高发现场的一组随访病例中 ,同时应用电子阴道镜和光学阴道镜检查诊断 ,以组织学为金标准 ,进行随机对比研究。结果 行宫颈活检的 16 3例患者中 ,组织学诊断为慢性炎症 10 3例 ;异常 6 0例 ,其中乳头状瘤 1例 ,宫颈上皮内瘤变 (CIN)Ⅰ级 37例 ,CINⅡ级 18例 ,CINⅢ级 4例。另行颈管刮术 33例 ,病理阳性 3例。电子阴道镜和光学阴道镜诊断宫颈阳性病变 (≥CINⅠ级 )的灵敏度分别为 83.3%和 95 .0 % ,差异无显著性 (P =0 .0 75 ) ;电子阴道镜和光学阴道镜的特异度、阳性预测值和准确率分别为 6 1.2 %和 2 1.4 %、5 5 .6 %和 4 1.3%、6 9.3%和 4 8.5 % ,差异有显著性 (P =0 .0 0 0 ,0 .0 35 ,0 .0 0 0 )。光学阴道镜和电子阴道镜在诊断≥CINⅡ级的宫颈病变中 ,其灵敏度、特异度、阳性预测值和准确率的差异 ,均无显著性。电子阴道镜和光学阴道镜的阴性预测值分别为86 .3%和 88.0 % ,差异无显著性 (P =0 .0 75 )。结论 电子阴道镜在诊断≥CINⅠ级的宫颈病变中 ,其特异度、阳性预测值和准确率均优于传统的光学阴道镜 ,但后者的灵敏度较高。在诊断≥CINⅡ级的病变中 ,两种阴道镜无差别。国产电?

Objective To evaluate the clinical value of domestically manufactured digital colposcope system(SLC-2000) in the detection of early cervical lesions. Methods During a follow-up study of patients in Xiangyuan county, Shanxi, a high risk area for cervical cancer, a digital colposcope and an optical colposcope were randomly used for diagnosis, with pathology as the gold standard. Results In 163 cervical biopsy specimens, 103 were diagnosed as chronic inflammation by histologic examination. Among 60 specimens which gave abnormal pathology, there were papilloma 1, cervical intra-epithelial neoplasia (CIN) Ⅰ 37, CIN Ⅱ 18 and CIN Ⅲ 4. In 33 endocervical curettage specimens, 3 were pathologically positive. Comparing the digital and optical colposcope in diagnosing the positive lesions of≥CIN Ⅰ,the sensitivity of the former and latter were 83.3% and 95.0%, the difference without being statistically significant (P=0.075). The specificity, positive predictive value, and accuracy of these two instruments were 61.2% , 21.4%, 55.6% and 41.3%, 69.3% 48.5%, with significant difference (P=0.000, P=0.035, and P=0.000). In diagnosing ≥CIN Ⅱcervical lesions, these three results of the two instruments did not show any significant difference either. The negative predictive value of the digital and optical colposcope were 86.3% and 88.0%, also showing no significant difference (P=0.075). Conclusion The specificity, positive predictive value, and accuracy of the digital colposcope in diagnosing cervical lesions ≥CIN Ⅰare all superior to those of the traditional optical colposcope, even though the sensitivity of the latter is higher. There is no difference between the two instruments in diagnosing lesions ≥CIN Ⅱ. Not only is domestic digital colposcope (SLC-2000) effective, but feasible and practical in the diagnosis, research and follow-up of cervical lesions.