CAJ | 학술논문

目的评价阴道镜下四象限活检在宫颈癌前病变筛查中的价值.方法利用1999年山西省襄垣县开展的1997例妇女的宫颈癌筛查横断面研究数据,比较阴道镜诊断宫颈高度鳞状上皮及以上病变(HSIL+)的敏感度、特异度和准确率等,同时比较阴道镜下四象限点活检与阴道镜下可疑病变活检病理结果.结果 1 997例筛查者中,病理诊断阴性l 784例(89.3％),低度鳞状上皮内病变(LSIL) 127例(6.4％),HSIL 74例(3.7％),鳞状细胞癌(SCC) 12例(0.6％).阴道镜检查为阴性1 478例(74.0％);阴道镜检查为阳性519例(26.0％),其中LSIL 463例(23.2％),HSIL 41例(2.1％),可疑癌15例(0.8％).阴道镜检查的阳性率为26.0％ (519/1997),与病理诊断结果的一致率为73.8％.以病理诊断为金标准,阴道镜检查发现HSIL+的敏感度为81.4％,特异度为76.5％.88例人乳头瘤病毒(HPV)阳性、液基细胞学(LBC)诊断未明确意义的非典型鳞状上皮细胞(ASC-US)及以上病变、阴道镜阴性患者中,病理诊断HSIL 14例(15.9％),LSIL 29例(33.0％);116例HPV阳性、LBC正常、阴道镜阴性患者中,病理诊断HSIL 2例(1.7％),LSIL 6例(5.2％).两组患者的HSIL和LSIL检出率差异均有统计学意义(均P＜0.001).阴道镜阴性的筛查者中,四象限活检对HSIL和LSIL病变的检出率分别为1.1％和4.7％.阴道镜检查结果异常519例,阴道镜下可疑病变活检与四象限活检诊断结果不一致19例,一致500例,符合率为96.3％.与四象限活检比较,若仅以阴道镜下异常象限进行指示性活检,则漏诊14.8％(19/128)的宫颈病变,其中漏诊8.6％ (5/58)的HSIL,漏诊24.1％(14/58)的LSIL.结论阴道镜下四象限活检能发现更多的宫颈病变,准确性高.作为宫颈癌前病变筛查的重要手段,阴道镜下四象限活检可提高宫颈癌前病变的检出率.
목적 평개음도경하사상한활검재궁경암전병변사사중적개치.방법 이용1999년산서성양원현개전적1997례부녀적궁경암사사횡단면연구수거,비교음도경진단궁경고도린상상피급이상병변(HSIL+)적민감도、특이도화준학솔등,동시비교음도경하사상한점활검여음도경하가의병변활검병리결과.결과 1 997례사사자중,병리진단음성l 784례(89.3％),저도린상상피내병변(LSIL) 127례(6.4％),HSIL 74례(3.7％),린상세포암(SCC) 12례(0.6％).음도경검사위음성1 478례(74.0％);음도경검사위양성519례(26.0％),기중LSIL 463례(23.2％),HSIL 41례(2.1％),가의암15례(0.8％).음도경검사적양성솔위26.0％ (519/1997),여병리진단결과적일치솔위73.8％.이병리진단위금표준,음도경검사발현HSIL+적민감도위81.4％,특이도위76.5％.88례인유두류병독(HPV)양성、액기세포학(LBC)진단미명학의의적비전형린상상피세포(ASC-US)급이상병변、음도경음성환자중,병리진단HSIL 14례(15.9％),LSIL 29례(33.0％);116례HPV양성、LBC정상、음도경음성환자중,병리진단HSIL 2례(1.7％),LSIL 6례(5.2％).량조환자적HSIL화LSIL검출솔차이균유통계학의의(균P＜0.001).음도경음성적사사자중,사상한활검대HSIL화LSIL병변적검출솔분별위1.1％화4.7％.음도경검사결과이상519례,음도경하가의병변활검여사상한활검진단결과불일치19례,일치500례,부합솔위96.3％.여사상한활검비교,약부이음도경하이상상한진행지시성활검,칙루진14.8％(19/128)적궁경병변,기중루진8.6％ (5/58)적HSIL,루진24.1％(14/58)적LSIL.결론 음도경하사상한활검능발현경다적궁경병변,준학성고.작위궁경암전병변사사적중요수단,음도경하사상한활검가제고궁경암전병변적검출솔.
Objective To evaluate the value of colposcopical 4-quadrant biopsies for detecting precancerous lesion in cervical cancer screening.Methods We used the data of a cross-sectional screening study in 1999, in which 1 997 women received cervical cancer screening in Xiang Yuan County, Shanxi province.The sensitivity, specificity and accuracy of both 4-quadrant biopsy and colposcopy directed biopsy to detect high-grade or more severe squamous intraepithelial lesions (HSIL+) were calculated.Results 1 784(89.3％) women who received 4-quadrant biopsies and endocervical curettage were negative.127(6.4％) women were diagnosed as LSIL, 74(3.7％) women as HSIL and 12(0.6％) cases of squamous cell carcinoma.1 478(74.0％) women who received biopsies in the sites of abnormal lesions were negative, 463(23.2％) cases of LSIL, 41(2.1％) cases of HSIL, 15(0.8％) cases of squamous cell carcinoma.The positive rate was 26.0％ (519/1 997) for colposcopy, and the coincidence rate was 73.7％ with pathological diagnosis.Sensitivity and specificity were 81.4％ and 76.5％ of colposcopy for HSIL+.In total of 519 women were found to be with any abnormal colposcopic appearance.The consistency rate between 4-quadrant biopsies and suspicious lesiondirected biopsies was 96.3％.By suspicious lesion-directed biopsy alone, 14.8％ cervical lesions were missdiagnosed, of which 8.6％(5/58) cases of total HSIL and 24.1％ (14/58) cases of all LSIL.Conclusions 4-quadrant biopsy can detect more HSIL+ lesions and is more accurate than suspicious lesion biopsy alone.As an important triage technique to detect cervical precancerous lesions, it can improve the detection rate of HSIL+ lesions in cervical cancer screening.