CAJ | 학술논문

目的探讨改变阳性标准对职业高危人群肺癌痰细胞学筛查灵敏度及特异度的影响.方法以1992-1999年间至少参加过1次年度性痰细胞学肺癌筛查的云南锡矿工人为研究对象,共9223名.研究对象年龄均40岁以上、井下工龄或冶炼工龄超过10年且无恶性肿瘤史.收集研究对象痰样进行筛查,以筛查阳性且被临床确诊的肺癌患者为真阳性,筛查阴性且在随访期间没有被临床诊断为肺癌的研究对象为真阴性,计算不同阳性标准痰细胞学筛查方法的灵敏度、特异度,并进行受试者工作特征曲线(ROC曲线)分析,利用Hanley和McNeil法计算Z值,比较不同阳性标准ROC曲线下面积的差别.结果截止到随访终止时间(2001年12月31日),9223名研究对象中共有500例肺癌患者,最常见的细胞类型为鳞癌[55.8%(222/398)],发病部位以中央型肺癌为主[68.5%(316/461)].在筛查过程中,共150例患者有痰细胞学筛查阳性史.阳性标准分别为重度不典型增生及以上、中度不典型增生及以上、轻度不典型增生及以上时,痰细胞学筛查方法灵敏度分别为30.0%(150/500)、36.4%(182/500)、53.0%(265/500);特异度分别为98.9%(8628/8723)、95.1%(8611/8723)、77.9%(7033/8723).3种阳性标准的ROC曲线下面积(由重度到轻度)分别为0.645(95%CI:0.635～0.654)、0.657(95%CI:0.668～0.667)、0.655(95%CI:0.645～0.664);重度与中度、轻度比较,以及中度与轻度比较,差异均无统计学意义(Z值分别为0.780、0.645、0.209,P值均>0.05).结论随阳性标准的降低,痰细胞学筛查的灵敏度上升而特异度下降,但3种不同阳性标准的准确度并无明显差异.
목적 탐토개변양성표준대직업고위인군폐암담세포학사사령민도급특이도적영향.방법 이1992-1999년간지소삼가과1차년도성담세포학폐암사사적운남석광공인위연구대상,공9223명.연구대상년령균40세이상、정하공령혹야련공령초과10년차무악성종류사.수집연구대상담양진행사사,이사사양성차피림상학진적폐암환자위진양성,사사음성차재수방기간몰유피림상진단위폐암적연구대상위진음성,계산불동양성표준담세포학사사방법적령민도、특이도,병진행수시자공작특정곡선(ROC곡선)분석,이용Hanley화McNeil법계산Z치,비교불동양성표준ROC곡선하면적적차별.결과 절지도수방종지시간(2001년12월31일),9223명연구대상중공유500례폐암환자,최상견적세포류형위린암[55.8%(222/398)],발병부위이중앙형폐암위주[68.5%(316/461)].재사사과정중,공150례환자유담세포학사사양성사.양성표준분별위중도불전형증생급이상、중도불전형증생급이상、경도불전형증생급이상시,담세포학사사방법령민도분별위30.0%(150/500)、36.4%(182/500)、53.0%(265/500);특이도분별위98.9%(8628/8723)、95.1%(8611/8723)、77.9%(7033/8723).3충양성표준적ROC곡선하면적(유중도도경도)분별위0.645(95%CI:0.635～0.654)、0.657(95%CI:0.668～0.667)、0.655(95%CI:0.645～0.664);중도여중도、경도비교,이급중도여경도비교,차이균무통계학의의(Z치분별위0.780、0.645、0.209,P치균>0.05).결론 수양성표준적강저,담세포학사사적령민도상승이특이도하강,단3충불동양성표준적준학도병무명현차이.
Objective To discuss the effect of different positive criteria on the sensitivity and specificity of sputum cytology screening for lung cancer among Yunnan tin miners.Methods 9223 Yunnan tin miners who received at least one annual sputum cytology screening for lung cancer during the period between 1992 and 1999 were recruited in the study.At time of enrollment,all participants were aged over 40 years old,had at least 10 years of employment as an underground miner and(or) smelter,and had not been diagnosed with malignancy.In our study,a true positive was categorized as having at least one prior positive sputum screening and a diagnosis of lung cancer,while a true negative,by our definition,signified negative sputum examinations and no diagnosis of lung cancer during the follow up time.Based on different positive criteria,sensitivity and specificity of sputum cytology were computed and receiver operating characteristic(ROC) curve analysis was conducted.Z statistic was used to test the differences of the area under ROC based on Hanley and McNeil method.Results By the end of following up on December 31,2001,a total 500 lung cancer cases were diagnosed among 9223 participants: most were squamous cell carcinoma (55.8% (222/398)) and central lung cancers (68.5% (316/461)).150 lung cancer cases had a previous positive sputum screening result.When positive criteria were taken as grave atypical metaplasia,moderate atypical metaplasia and slight atypical metaplasia,the corresponding sensitivities were 30.0% (150/500),36.4% (182/500),53.0% (265/500) respectively; while the corresponding specificities were 98.9% (8628/8723),95.1% (8611/8723),77.9% (7033/8723) respectively.The areas under ROC curve according to different positive criterias were 0.645(95%CI: 0.635-0.654),0.657(95%CI: 0.668-0.667),0.655(95%CI: 0.645-0.664) respectively.There were no significant differences found in the comparisons between grave and moderate atypical metaplasia,grave and slight atypical metaplasia,moderate and slight atypical metaplasia(Z statistics were 0.780,0.645,0.209 respectively,all P values>0.05).Conclusion While the standard of positive criteria for diagnosis of lung cancer decreased,the sensitivity of sputum cytology screening increased and the specificity decreased.Since there were no significant differences of accuracy for different positive criteria.