CAJ | 학술논문

目的：探讨阴道镜检查在围绝经期妇女宫颈癌筛查中的应用价值。方法选择1288例于沈阳市妇婴医院院妇科门诊进行妇科疾病检查的围绝经期妇女为研究对象,所有患者均分别进行宫颈阴道镜、细胞学、HPV-DNA检查,上述3项检查中任何一项异常即进行病理组织活检,以病理学活检作为诊断试验的金标准,分别计算其他3种检测方法的诊断学实验评价指标,并绘制受试者工作曲线。结果经病理检查诊断宫颈病变阴性1032例(80.12%),CINⅠ级病变99例(7.69%)、CINⅡ级病变72例(5.59%)、CINⅢ级病变58例(4.50%)、浸润性癌27例(2.10%)。以病理学检查结果作为金标准,细胞学检查正确诊断宫颈病变阳性235例、阴性802例；诊断宫颈病变的灵敏度为91.80%、特异度为77.71%、曲线下面积(A UC)为0.912。HPV-DNA检查正确诊断宫颈病变阳性241例、阴性798例；诊断宫颈病变的灵敏度为94.14%、特异度为77.33%、A UC为0.923。阴道镜检查正确诊断宫颈病变阳性176例、阴性598例；诊断宫颈病变的灵敏度为68.75%、特异度为57.95%、A UC为0.711。结论细胞学、HPV-DNA检查结果与病理组织学活检结果最为接近,阴道镜检查具有方便快速,成本低廉的优势,可以作为初步筛检的一种有效手段。
목적：탐토음도경검사재위절경기부녀궁경암사사중적응용개치。방법선택1288례우침양시부영의원원부과문진진행부과질병검사적위절경기부녀위연구대상,소유환자균분별진행궁경음도경、세포학、HPV-DNA검사,상술3항검사중임하일항이상즉진행병리조직활검,이병이학활검작위진단시험적금표준,분별계산기타3충검측방법적진단학실험평개지표,병회제수시자공작곡선。결과경병리검사진단궁경병변음성1032례(80.12%),CINⅠ급병변99례(7.69%)、CINⅡ급병변72례(5.59%)、CINⅢ급병변58례(4.50%)、침윤성암27례(2.10%)。이병이학검사결과작위금표준,세포학검사정학진단궁경병변양성235례、음성802례；진단궁경병변적령민도위91.80%、특이도위77.71%、곡선하면적(A UC)위0.912。HPV-DNA검사정학진단궁경병변양성241례、음성798례；진단궁경병변적령민도위94.14%、특이도위77.33%、A UC위0.923。음도경검사정학진단궁경병변양성176례、음성598례；진단궁경병변적령민도위68.75%、특이도위57.95%、A UC위0.711。결론세포학、HPV-DNA검사결과여병리조직학활검결과최위접근,음도경검사구유방편쾌속,성본저렴적우세,가이작위초보사검적일충유효수단。
Objective To explore the application value of colposcopy in perimenopausal women in the screening of cervical cancer. Methods 1288 cases of perimenopausal women in outpatient department of Women and Children Hospital of Shenyang were selected, all patients were underwent colposcopy, cytology, HPV-DNA, and pathological biopsy according to the pathological biopsy as the gold standard diagnostic test, diagnostic calculation of other three methods for the detection of the experimental evaluation index respectively, and the receiver operating characteristic curve (ROC curve) was drawn. Results Pathological examination of industry and the diagnosis of cervical lesions and negative in 1032 patients (80.12%), CIN gradeⅠlesions in 99 cases (7.69%), CIN gradeIIlesions in 72 cases (5.59%), CIN grade Ⅲ lesions in 58 cases (4.50%), 27 patients with invasive carcinoma (2.10%). According to the pathological examination results as the gold standard, the correct diagnosis of cervical lesion cytology was positive in 235 cases, 802 cases were negative; in the diagnosis of cervical lesion, the sensitivity was 91.80%, specificity was 77.71%, A UC was 0.912. The correct diagnosis of HPV-DNA in cervical lesions was positive in 241 cases, negative in 798 cases; the diagnosis of cervical lesions, the sensitivity was 94.14%, specificity was 77.33%, A UC was 0.923. In diagnosis of cervical lesions, 176 cases of positive and 598 cases of negative were correctly diagnosed by colposcopy; the sensitivity of cervical lesions was 68.75%, specificity was 57.95%, A UC was 0.711. Conclusion Results of cytology and HPV-DNA are closest to the histopathological biopsy results, colposcopy has the advantages of convenient, fast and low cost, can be used as an effective means of preliminary screening.