贵州老年女性宫颈癌筛查的分析评价

发布时间：2018-01-31 19:00

本文关键词： 老年女性宫颈上皮内瘤变乳头状瘤病毒人宫颈液基细胞学阴道镜检查活组织检查　出处：《现代妇产科进展》2017年06期 　论文类型：期刊论文

【摘要】：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。
[Abstract]:Objective: to evaluate cervical cytology. High risk human papillomavirus (HPV). Efficacy of DNA and colposcopy in screening cervical lesions in elderly women. Methods:. To analyze the cervical cancer screening data of 602 women over 50 years old who underwent colposcopy and pathological biopsy under colposcopy in gynecologic colposcopy clinic of affiliated hospital of Guizhou Medical University. Comparative cytology, high risk HPV DNA and colposcopy were used to screen cervical lesions in elderly women. Pathological diagnosis showed that 221 cases of CINIII / III and 88 cases of cervical cancer were diagnosed as cervical lesions of high grade or above. Cervical cytology was used to screen cervical lesions of high grade or above. The sensitivity, specificity, positive predictive value and negative predictive value of ASCUS were 43.4% and 88.4%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of LSIL were 59.2% and 74.6%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of HSIL were 30.5% and 74.8%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of high-risk type HPV DNA were 71.2% and 69.49.43%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of high-risk HPV DNA combined with cytology were 100%. 22.67 54.7% and 100%; The coincidence rate of colposcopy diagnosis and cervical pathological diagnosis was 63.51 and the consistency test Kappa value was 0.631. The sensitivity, positive predictive value and specificity of colposcopy were 74.3 and 72.2, respectively. The specificity of colposcopy for lower grade cervical lesions and lower cervical lesions was 89.4%. Negative predictive value was 90.4, false positive rate was 10.6, false negative rate was 25.70.Conclusion: cytological examination is an effective screening method for cervical cancer in elderly women. Cytology combined with HPV DNA screening can improve sensitivity and negative predictive value, and colposcopy can improve the diagnostic rate. The combination of the three methods will be more beneficial to the scientific management of cervical lesions.
【作者单位】：贵州医科大学第一附属医院妇产科;
【分类号】：R737.33
【正文快照】： 宫颈癌是妇科最常见的恶性肿瘤,其高发年龄50~55岁[1]。随着中国老年人口的增加,老年宫颈癌患者数随之增加。进行合理而有效的宫颈癌筛查,及早发现宫颈高级别病变并给予及时处理是降低宫颈癌发病率、死亡率的关键。老年女性由于其生理的特殊性,不能及早诊治,发现时往往期别较

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