摘要
目的 研究阴道镜检查中子宫颈碘染色试验对子宫颈癌前病变的诊断价值,评估碘染色成像技术与子宫颈病变程度之间的关联性。方法 纳入2020年1~12月在北京大学第一医院妇产科子宫颈诊疗中心接受阴道镜检查的2163例患者,根据《子宫颈癌前病变诊断与治疗规范》团体标准进行阴道镜拟诊,记录活检结果,并统计分析。结果 2163例阴道镜检查患者中,783例取活检,活检率为36.20%;组织病理学诊断为子宫颈上皮内瘤变(CIN)2+者为402例(18.59%)。阴道镜检查对高级别病变的拟诊结果与活检病理结果的符合率为83.03%。阴道镜检查的诊断敏感度为91.54%,特异度为87.34%,阴性预测值为97.84%,阳性预测值为62.27%,总体符合率为88.12%。碘试验不着色图形与醋白上皮一致组的CIN2+的发生率为59.22%,明显高于不一致组(32.38%),差异有统计学意义(P<0.05)。此外,无醋白无碘不着色区和有碘不着色区分别为388例和663例,均拟诊为正常阴道镜所见。结论 阴道镜检查中,无醋白上皮时无需再参考碘染色成像图形;如醋白上皮出现,碘染色图形与醋白上皮染色一致且均匀分布,可能存在CIN2+,建议取活检以明确诊断。如碘染色成像图形与醋白上皮染色不一致或呈不均匀分布,只是有可能存在高级别病变的风险,此时应谨慎考虑是否活检,以免过度诊断。
Objective To study the diagnostic value of cervical iodine staining test in colposcopy for cervical precancerous lesions,and evaluate the correlation between iodine staining imaging and the degree of cervical lesions.Methods The study included 2163 patients who underwent colposcopy at Peking University First Hospital Cervical Diagnostic and Treatment Center between January and December 2020;according to the group standard of The Diagnosis and Treatment Standard of Cervical Precancerous Lesion,colposcopic diagnosis was made,the biopsy results were recorded and analyzed statistically.Results Of the 2163 patients who underwent colposcopic examination,783 patients underwent biopsy,and the biopsy rate was 36.20%.Among them,402 had histopathological diagnosed of CIN2+(cervical intraepithelial neoplasia grade 2 or higher),and the incidence of CIN2+was 18.59%.The coincidence rate of colposcopy with biopsy was 83.03%.The sensitivity,specificity,negative predictive value,and positive predictive value of colposcopy and the total matching ratio were 91.54%,87.34%,97.84%,62.27%,and 88.12%,respectively.The incidence of pathological CIN2+was 59.22%in the iodine test when the non-stained pattern was consistent with the vinegar white epithelium,which was significantly higher than the 32.38%in the inconsistent group,and the difference was statistically significant(P<0.05).In addition,there were 388 cases of non-stained areas without vinegar or iodine,and 663 cases of non-stained areas with iodine,all of which were suspected to be seen under normal colposcopy.Conclusions In colposcopy,there is no need to refer to iodine staining imaging patterns when there is no vinegar white epithelium.If vinegar white epithelium appears and the iodine staining pattern is consistent with vinegar white epithelium staining and evenly distributed,there may be CIN2+present.It is recommended to take a biopsy to confirm the diagnosis.If the iodine staining pattern is inconsistent with the vinegar white epithelial staining or unevenly distributed,there m
作者
赵健
李俊霞
王婷婷
冯慧
董建新
崔荣荣
董颖
张岩
ZHAO Jian;LI Jun-xia;WANG Ting-ting;FENG Hui;DONG Jian-xin;CUI Rong-rong;DONG Ying;ZHANG Yan(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China;不详)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2024年第3期362-365,共4页
Chinese Journal of Practical Gynecology and Obstetrics
基金
国家重点研发计划(2020AAA0105200)。
关键词
子宫颈癌筛查
子宫颈癌前病变
阴道镜拟诊
碘染色成像
cervical cancer screening
cervical precancerous lesions
colposcopy diagnosis
iodine staining
