卢戈氏碘染色在冷冻诊断宫颈鳞状上皮内病变中的应用

发布时间：2018-04-05 15:37

  本文选题：快速冷冻诊断　切入点：卢戈氏碘　出处：《郑州大学》2017年硕士论文

【摘要】：目的评估快速冷冻诊断对宫颈鳞状上皮内病变的诊断准确性与局限性。分析快速冷冻检查时,探讨卢戈氏碘试验肉眼观察(visual inspection with lugol’s iodine,VILI)法在冷冻诊断宫颈鳞状上皮内病变中的价值。方法收集2016年3月至2016年7月郑州大学第一附属医院行快速冷冻检查(frozen section examination,FSE)的宫颈锥切病例共384例。最终筛选出294例病例做回顾性分析。患者介于18~90岁年龄之间,年龄平均为43.54岁。其中150例锥切标本未行VILI实验;另144例锥切标本行VILI实验。如常规诊断为可疑诊断,再行免疫组化协诊后得出最终常规诊断。所有纳入研究的患者均符合宫颈锥切术适应症等纳入标准并均已签署知情同意书。使用SPSS17.0软件,比较FSE诊断与最终常规石蜡检查(paraffin section xamination,PSE)诊断的各项统计学数据,如阳性预测值(positive predictive value,+PV)、阴性预测值(negative predictive value,-PV)、真阳性率即灵敏度(sensitivity,Se)、真阴性率即特异度(specificity,Sp)、阳性似然比(positive likelihood ratio,+LR)、阴性似然比(negative likelihood ratio,-LR)、正确指数即约登指数(Youden's index)和诊断优势比(diagnostic odds ratio,DOR)和符合率。并对以上指标进行数据统计学分析。以百分率表示计数资料,使用χ2检验对数据进行计数资料的统计学分析,以α=0.05为检验水准。结果VILI组:在FSE宫颈炎性病变诊断方面,其Se、Sp、+PV、-PV、+LR、-LR、DOR、Youden's index和符合率分别为94.12%、72.73%、77.53%、92.52%、3.45、0.08、2.67、0.67和77.78%,在FSE宫颈低级别上皮内病变(low-grade squamous intraepithelial lesion,LSIL)诊断方面,其Se、Sp、+PV、-PV、+LR、-LR、DOR、Youden's index和符合率分别为57.14%、89.91%、84.99%、67.72%、5.66、0.48、11.88、0.47和81.94%;在FSE宫颈高级别上皮内病变(high-grade squamous intraepithelial lesion,HSIL)诊断方面,其Se、Sp、+PV、-PV、+LR、-LR、DOR、Youden's index和符合率分别为66.67%、98.55%、97.87%、74.73%、46.00、0.34、136.00、0.65和81.94%。非VILI组:在FSE宫颈炎性病变诊断方面,其Se、Sp、+PV、-PV、+LR、-LR、DOR、Youden's index和符合率分别为96.77%、58.82%、70.15%、94.80%、2.35、0.05、42.86、0.56和66.66%;在FSE宫颈LSIL诊断方面,其Se、Sp、+PV、-PV、+LR、-LR、DOR、Youden's index和符合率分别为35.62%、89.51%、74.72%、57.79%、2.96、0.65、4.45、0.24和80.00%;在FSE宫颈HSIL诊断方面,其Se、Sp、+PV、-PV、+LR、-LR、DOR、Youden's index和符合率分别为51.62%、98.25%、96.71%、67.00%、29.42、0.49、59.73、0.49和69.33%。通过χ2检验,VILI组准确率(70.83%)高于非VILI组(58%),两组实验诊断准确性上存在差异,差异具有统计学意义(P0.05)。结论VILI有助于提高冷冻检查时对宫颈上皮内病变的诊断准确率。
[Abstract]:Objective to evaluate the accuracy and limitation of rapid frozen diagnosis for cervical squamous intraepithelial lesions.To investigate the value of Lugo's iodine test in the diagnosis of cervical squamous intraepithelial lesions by using visual inspection with lugol's iodine vii.Methods from March 2016 to July 2016, 384 cases of cervical conization were collected from the first affiliated Hospital of Zhengzhou University.294 cases were selected for retrospective analysis.The patient was between 18 and 90 years old, with an average age of 43.54 years.VILI test was not performed in 150 conical specimens and VILI test was performed in 144 conical specimens.If the routine diagnosis is suspicious, the final routine diagnosis can be obtained by immunohistochemistry.All patients included in the study met the inclusion criteria for cervical conization and signed informed consent.SPSS17.0 software was used to compare the statistical data between FSE diagnosis and final routine paraffin examination (PSE).Diagnostic odds and coincidence rate.And the above indicators were statistically analyzed.The counting data were expressed by percentage, and the count data were analyzed statistically by 蠂 2 test, and the test level was 伪 0.05.鍏禨e,Sp, PV,-PV, LR,-LR,DOR,Youden's index鍜岀�﹀悎鐜囧垎鍒�涓，

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