阴道镜联合宫颈液基细胞学检查对宫颈上皮内瘤变Ⅱ及以上病变漏检的影响因素分析OA
Analysis of the influencing factors of missed detection of cervical intraepithelial neoplasia grade Ⅱ and above by colposcopy combined with cervical
目的 探讨阴道镜与宫颈液基细胞学检查(TCT)联合筛查宫颈上皮内瘤变(CIN)Ⅱ及以上病变漏检的影响因素.方法 选取2021年1月—2024年1月因出现白带异常、接触性出血、宫颈糜烂或息肉等症状、体征,或因健康体检发现宫颈可疑病变而行阴道镜下活检诊断为CIN的患者78例为研究对象,年龄27～66(39.54±9.28)岁.患者入院后均行阴道镜检查和TCT,以宫颈环形电切术术后病理检查结果为金标准,判断阴道镜、TCT单一检查以及联合筛查CIN Ⅱ及以上病变的敏感度、特异度、阳性预测值以及漏诊率,采用单因素、多因素Logistic回归分析影响CIN Ⅱ及以上病变漏诊的危险因素.结果 TCT诊断CIN Ⅱ及以上病变的敏感度为38.30％(18/47)、特异度为77.42％(24/31)、阳性预测值为72.00％(18/25)、漏诊率为61.70％(29/47);阴道镜检查诊断CIN Ⅱ及以上病变的敏感度为42.55％(20/47)、特异度为74.19％(23/31)、阳性预测值为71.43％(20/28)、漏诊率为57.45％(27/47).阴道镜检查联合TCT诊断CIN Ⅱ及以上病变的敏感度为70.21％(33/47)、特异度为80.64％(25/31)、阳性预测值为84.62％(33/39)、漏诊率为29.79％(14/47).患者年龄≥40岁、阴道镜图像不清晰、宫颈病变面积<1/2、活检标本数1个为CIN Ⅱ及以上病变漏诊的独立危险因素(P<0.05).结论 阴道镜检查联合TCT能提高筛查CIN Ⅱ及以上病变的敏感度、特异度、阳性预测值,降低漏诊率,但仍存在一定的漏诊情况.而患者年龄≥40岁、阴道镜图像不清晰、宫颈病变面积<1/2、活检标本数1个为CIN Ⅱ及以上病变漏诊的独立危险因素.
Objective To investigate the influencing factors of missed detection of cervical intraepithelial neoplasia(CIN)grade Ⅱ and above through colposcopy combined with cervical liquid-based cytology(LBC,commonly known as TCT in China)screening.Methods A total of 78 patients who presented with symptoms and signs such as abnormal vaginal discharge,contact bleeding,cervical erosion or polyps,or were diagnosed with suspected cervical lesions through health check-ups and underwent colposcopy-guided biopsy from January 2021 to January 2024 were selected as the study subjects.The patients'ages ranged from 27 to 66(39.54±9.28)years.After admission,all patients underwent colposcopy and TCT.The postoperative pathological examination results of cervical loop electrosurgical excision procedure(LEEP)were used as the gold standard to evaluate the sensitivity,specificity,positive predictive value,and missed diagnosis rate of colposcopy and TCT alone and in combination in screening CIN grade Ⅱ or higher.Univariate and multivariate logistic regression analyses were used to determine the risk factors affecting the missed diagnosis of CIN grade Ⅱ or higher.Results The sensitivity of TCT in diagnosing CIN grade Ⅱ or higher was 38.30％(18/47),the specificity was 77.42％(24/31),the positive predictive value was 72.00％(18/25),and the missed diagnosis rate was 61.70％(29/47);the sensitivity of colposcopy in diagnosing CIN grade Ⅱ or higher lesions was 42.55％(20/47),the specificity was 74.19％(23/31),the positive predictive value was 71.43％(20/28),and the missed diagnosis rate was 57.45％(27/47).The sensitivity of colposcopy combined with TCT in diagnosing CIN grade Ⅱ or higher was 70.21％(33/47),the specificity was 80.64％(25/31),the positive predictive value was 84.62％(33/39),and the missed diagnosis rate was 29.79％(14/47).Patient age≥40 years,unclear colposcopy images,cervical lesion area<1/2,and a single biopsy specimen were independent risk factors for missed diagnosis of CIN grade Ⅱ or higher(P<0.05).Conclusion Colposcopy combined with TCT can enhance the sensitivity,specificity,positive predictive value in screening for CIN grade Ⅱ or higher,reduce the rate of missed diagnoses,but there are still some cases of missed diagnoses.The patient's age≥40 years,unclear colposcopy images,cervical lesion area<1/2,and a single biopsy specimen are independent risk factors for missed diagnoses of CIN grade Ⅱ or higher.
王婷婷
亳州市妇幼保健院妇产科,安徽亳州 236800
宫颈上皮内瘤变阴道镜宫颈液基细胞学检查宫颈环形电切术漏检危险因素病理检查
cervical intraepithelial neoplasiacolposcopecervical thin-prep cytologic testloop electrosurgical excision proceduremissed detectionrisk factorpathological examination
《临床误诊误治》 2026 (9)
59-64,6
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