摘要
【目的】探讨R-WAY诊断系统在阴道镜下诊断宫颈高级别病变中的应用价值并初步探讨其理论依据。【方法】选取行阴道镜检查并经病理活检的病例390例,分别应用R-WAY系统和ASCCP2017标准判读检查结果,并比较二者的灵敏度、特异度、阳性预测值、阴性预测值、约登指数及与病理结果的符合率。选取经病理确诊为高级别鳞状上皮内瘤变(high grade squamous intraepithelial lesion,HSIL)及浸润癌(HSIL+)的病例122例和低级别病变(low-grade squamous intraepithelial lesion,LSIL)病例89例,计数HSIL+和LSIL病变基底部血管密度及血管直径。【结果】R-WAY系统和ASCCP2017标准的灵敏度、特异度、阳性预测值、阴性预测值、约登指数及与病理结果的符合率分别为91.80%和69.67%、89.55%和88.80%、80.00%和73.91%、96.00%和86.54%、81.35%和58.47%、90.26%和82.82%,其中R-WAY系统灵敏度和阴性预测值均显著高于ASCCP2017标准(P<0.001)。HISL+组和LSIL组病变基底部血管密度分别为(8.06±3.42)和(5.76±2.91)个/HPF、血管直径分别为(21.91±6.67)和(15.27±3.83)μm,HSIL+组均显著高于LSIL组(P=0.000)。伴有乳头状结构的LSIL组血管密度和血管直径分别为(9.50±1.68)和(19.73±4.79)μm,二者与HSIL+组相比均无显著差异(P>0.05)。【结论】R-WAY诊断系统可用于阴道镜下诊断宫颈HSIL+,HSIL+病变基底部血管改变是其理论依据之一,病变局部具有乳头状结构可能是阴道镜下过诊HSIL+的原因之一。
【Objective】To investigate the application value of R-WAY colposcopy evaluation system in the diagnosis of high-grade squamous intraepithelial lesion (HSIL) of the cervix and explore its theoretical basis.【Methods】A total of 390 cases undergoing colposcopy and biopsy were selected. The results were evaluated by R-WAY system and ASCCP2017 criteria, respectively. The sensitivity, specificity, PPV, NPV, Youden index and coincidence rate of pathological results were compared. The vascular densities and diameters at the base of the lesions were detected in 122 cases of HSIL+(HSIL and invasive cancer) and 89 cases of low-grade squamous intraepithelial lesion (LSIL).【Results】According to R-WAY system and ASCCP2017 criteria, the sensitivity, specificity, PPV, NPV, Youden index and coincidence rate of pathological results were 91.80% vs 69.67%, 89.55% ys 88.80%, 80.00% vs 73.91%, 96.00% vs 86.54%, 81.35% vs 58.47% and 90.26% vs 82.82%, respectively. The sensitivity and NPV of R-WAY system were significantly higher than those of ASCCP2017 criteria (P<0.001). The vascular densities and diameters in HSIL + group and LSIL group were (8.06±3.42) vs (5.76±2.91) and (21.91±6.67)μm vs (15.27±3.83)μm, respectively. The former was significantly higher than the latter (P=0.000). The vascular densities and diameters of LSIL with papillary structure were (9.50±1.68) and (19.73±4.79)μm, respectively. Compared with those of the HSIL group, the differences were not statistically significant (P>0.05).【Conclusion】R-WAY system can be used to diagnose HSIL + of the cervix under colposcopy. The changes of blood vessels at the base of the lesions may be one of its theoretical bases, and localized papillary structure may contribute to the overdiagnosis of LSIL as HSIL+ under colposcopy.
作者
李艳
谷彦军
杨玉芳
穆艳月
LI Yan;GU Yan-jun;YANG Yu-fang;MU Yan-yue(Department of Obstetric and Gynecology, Tianjin Union MedicalCenter, Tianjin 300121, China)
出处
《武警后勤学院学报（医学版）》
CAS
2018年第9期744-746,751,共4页
Journal of Logistics University of PAP（Medical Sciences）
