摘要
目的探究阴道镜下宫颈组织活检对宫颈病变的诊断准确性及漏诊因素。方法回顾分析2018年8月—2021年4月本院收治的221例宫颈病变患者的临床资料,所有患者均接受阴道镜活检与手术病理检查,以手术病理结果为金标准建立接受者操作特征(ROC)曲线分析阴道镜活检诊断效能,收集患者临床资料建立Logistic回归模型分析阴道镜活检漏误诊因素。结果病理结果显示,221例患者中宫颈炎85例(38.46%)、CINⅠ67例(30.32%)、CINⅡ-Ⅲ54例(24.43%)、原位/浸润癌15例(6.79%),经阴道镜活检准确诊断共154例,漏误诊67例(30.32%);ROC显示,阴道镜活检对宫颈炎(95%CI:0.831-0.917;AUC:0.720)、CINⅠ(95%CI:0.831-0.879;AUC:0.775)、CINⅡ-Ⅲ(95%CI:0.844-0.910;AUC:0.731)、宫颈癌(95%CI:0.912-0.953;AUC:0.893)均具有较高诊断效能;Logistic回归模型显示,宫颈病变范围小(95%CI:1.275-2.470;OR:1.521)、组织样本数少(95%CI:1.280-2.472;OR:1.573)、未开展ECC(95%CI:1.284-2.467;OR:1.695)、图像质量差(95%CI:2.990-4.560;OR:3.835)是阴道镜活检诊断宫颈病变的漏误诊影响因素。结论阴道镜活检技术可对宫颈病变患者病理类型进行准确定性诊断,而小范围宫颈病变、图像质量差的患者漏误诊风险较高,通过开展ECC、多组织样本取样可降低漏误诊风险。
Objective To explore the diagnostic accuracy of cervical biopsy under colposcopy in diagnosing cervical lesions and missed diagnosis factors.Methods The clinical data of 221 patients suffered with cervical lesions those were admitted to our hospital from August 2018 to April 2021 were retrospectively analyzed.All patients received colposcopic biopsy and surgical pathology examination.Receiver operating characteristic(ROC)curve was established to analyze the diagnostic efficiency of colposcopic biopsy based on the results of surgical pathology.The clinical data of patients were collected and logistic regression model was established to analyze the missed diagnosis and misdiagnosis factors of colposcopic biopsy.Results According to the pathology results,among 221 cases,85 cases(38.46%)were suffered with cervicitis,67 cases(30.32%)were CINⅠ,54 cases(24.43%)were CIN Ⅱ-Ⅲ,and 15 cases(6.79%)were in situ/invasive carcinoma.Colposcopic biopsy accurately diagnosis of 154 cases,however,67 cases(30.32%)were missed diagnosed and misdiagnosed.ROC showed that colposcopic biopsy had a significant efficiency in diagnosing cervicitis(95%CI:0.831-0.917;AUC:0.720),CINⅠ(95%CI:0.831-0.879;AUC:0.775),CIN Ⅱ-Ⅲ(95%CI:0.844-0.910;AUC:0.731),and cervical cancer(95%CI:0.912-0.953;AUC:0.893).Logistic regression model showed that the scope of cervical lesions was small(95%CI:1.275-2.470;OR:0.521),less tissue samples(95%CI:1.280-2.472;OR:1.573),no ECC(95%CI:1.284-2.467;OR:1.695),poor image quality(95%CI:2.990-4.560;OR:1;835)were the influencing factor of missed diagnosis and misdiagnosis in the diagnosis of cervical lesions by colposcopy biopsy.Conclusions Colposcopic biopsy technology could accurately diagnose the pathological types of cervical lesions,and the risk of missed diagnosis and misdiagnosis is higher in patients with small-scale cervical lesions and poor image quality.ECC and multi tissue sampling could reduce the risk of missed diagnosis and misdiagnosis.
作者
许秀玲
唐移忠
朱艳辉
Xu Xiuling;Tang Yizhong;Zhu Yanhui(First ward of Gynecology and Obstetrics department,the third affiliated hospital of Guangdong Medical University(Longjiang hospital,Shunde District),Foshan,Guangdong,528318,China)
出处
《齐齐哈尔医学院学报》
2022年第15期1444-1448,共5页
Journal of Qiqihar Medical University
关键词
宫颈病变
阴道镜子宫颈活组织检查
漏误诊因素
诊断价值
Cervical lesions
Colposcopic cervical biopsy
Factors of missed diagnosis and misdiagnosis
Diagnostic value
