论文部分内容阅读
目的:评价宫颈细胞学、高危型人乳头瘤病毒(HPV)DNA检测及阴道镜检查对老年女性宫颈病变筛查的效力。方法:分析于贵州医科大学附属医院妇科阴道镜门诊行阴道镜检查并行阴道镜下病理活检的602例50岁以上老年女性的宫颈癌筛查资料,比较细胞学、高危型HPV DNA检测与阴道镜检查在老年女性宫颈病变筛查中的意义。结果:602例老年女性中,病理学诊断为宫颈高级别以上病变221例(CINII/III 133例,宫颈癌88例)占36.7%。宫颈细胞学筛查宫颈高级别以上病变,以ASCUS为分界点的灵敏度、特异度、阳性预测值和阴性预测值分别为86.7%、47.3%、43.4%和88.4%;以LSIL为分界点的灵敏度、特异度、阳性预测值和阴性预测值分别为35.2%、88.7%、59.2%和74.6%;以HSIL为分界点的灵敏度、特异度、阳性预测值和阴性预测值分别为30.5%、96.0%、78.0%和74.8%;高危型HPV DNA分型检测宫颈高级别以上病变的灵敏度、特异度、阳性预测值和阴性预测值分别为71.2%、32.3%、34.3%和69.4%;高危型HPV DNA检测联合细胞学(≥ASCUS)检查筛查宫颈高级别以上病变的灵敏度、特异度、阳性预测值和阴性预测值分别为100%、22.67%、54.7%和100%;阴道镜诊断与子宫颈病理诊断的完全符合率为63.51%,一致性检验Kappa值为0.631,阴道镜印象宫颈高级别病变及以上病变的敏感度为74.3%、阳性预测值为72.2%、阴道镜对于宫颈低级别病变及以下病变的特异度为89.4%,阴性预测值为90.4%,假阳性率为10.6%,假阴性率为25.7%。结论:对老年女性,细胞学检查是有效的宫颈癌筛查方法,细胞学联合HPV DNA筛查可使敏感度和阴性预测值提高,阴道镜检查可提高诊断率,三者结合应用将更有利于宫颈病变的科学管理。
Objective: To evaluate the efficacy of cervical cytology, high-risk human papillomavirus (HPV) DNA testing and colposcopy in the screening of elderly women with cervical lesions. Methods: The data of cervical cancer screening in 602 elderly women over 50 years of age undergoing colposcopy with colposcopy under colposcopy were analyzed in the Gynecologic Colposcopy Clinic of Affiliated Hospital of Guizhou Medical University. The cytology, high-risk HPV DNA test and colposcopy Check the significance of cervical screening in elderly women. Results: Of the 602 elderly women, pathological diagnosis of 221 cases of high grade cervical lesions (CINII / III 133 cases, 88 cases of cervical cancer) accounted for 36.7%. Sensitivity, specificity, positive predictive value and negative predictive value were 86.7%, 47.3%, 43.4% and 88.4%, respectively, with ASCUS as the cut-off point. Cervical cytology , Specificity, positive predictive value and negative predictive value were 35.2%, 88.7%, 59.2% and 74.6% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of HSIL as the cut-off point were 30.5%, 96.0% , 78.0% and 74.8%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of high risk HPV DNA typing in detecting high grade cervical lesions were 71.2%, 32.3%, 34.3% and 69.4% Sensitivity, specificity, positive predictive value and negative predictive value were 100%, 22.67%, 54.7% and 100% for the detection of high grade cervical lesions by combined cytology (≥ASCUS). Colposcopy and cervical pathology The diagnostic coincidence rate was 63.51%, the consistency test Kappa value was 0.631, the sensitivity of colposcopy to high-grade cervical lesions and above lesions was 74.3%, and the positive predictive value was 72.2%. Colposcopy was used to detect cervical low-grade lesions and below Special disease Degree of 89.4%, negative predictive value 90.4%, 10.6% false positive rate and false negative rate of 25.7%. Conclusion: Cytology is an effective screening method for cervical cancer in elderly women. Cytology combined with HPV DNA screening can increase the sensitivity and negative predictive value. Colposcopy can improve the diagnosis rate, and the combination of the three will have more Conducive to the scientific management of cervical lesions.