电子阴道镜对宫颈病变的诊断价值

发布时间：2018-04-24 14:12

  本文选题：电子阴道镜 + 宫颈病变　； 参考：《大连医科大学》2014年硕士论文

【摘要】：目的：将阴道镜诊断与阴道镜下活组织检查后的病理诊断进行对比，并总结异常阴道镜图像与宫颈病变的关系，评估电子阴道镜对宫颈病变的诊断价值，，探讨其临床意义。方法：回顾性分析大连医科大学附属第一医院妇科门诊2011年1月至2013年8月之间行阴道镜检查并活检的863例患者的一般资料和阴道镜图像，对患者阴道镜诊断与活检或手术的病理诊断进行对比分析。结果：阴道镜下检查并活检863例，阴道镜拟诊为正常/慢性宫颈炎的共459例，CINI的共174例，CINII的127例，CINIII的103例，病理结果示正常/慢性宫颈炎523例，CINI132例，CINII100例，CINIII108例；阴道镜诊断与病理诊断的总体符合率为83.31%。阴道镜对宫颈病变总体诊断符合率为71.78％，灵敏度为85．29％，特异度为79．01％，假阳性率为20．99％，假阴性率为14．71％。其中对CINI的诊断符合率为60.92%，灵敏度为80.30%，特异度为90.70%，假阳性率为9.30%，假阴性率为19.70%；对CINII-III的诊断符合率为80.00%，灵敏度为88.46%，特异度为94.66%，假阳性率为5.34%，假阴性率为11.54%。阴道镜拟诊结果与病理诊断结果存在较高度的一致性（Kappa系数=0.729，P=0.000）。阴道镜对CINII-III的诊断符合率、灵敏度、特异度均明显高于对CINI的诊断符合率、灵敏度、特异度（P＜0.05）。结论：阴道镜在宫颈病变诊断中具有重要应用价值；阴道镜下出现致密醋酸白上皮、镶嵌、白斑等改变意味高级别病变可能性大，应高度警惕；阴道镜对低级别病变（≤CINI）的过度诊断率（5.33%）和重度病变（CINIII）的诊断不足率（0）均很低，有利于避免过度诊断或漏诊，但对中度病变（CINII）诊断不足的可能性较高（27.55%），有待于研究和提高；阴道镜对CINI诊断不足率为35.06%，提示对阴道镜拟诊为正常或慢性炎症者应结合HPV结果综合判断正确随诊。
[Abstract]:Objective: to compare the pathological diagnosis of colposcopy with that of biopsy under colposcopy, summarize the relationship between abnormal colposcopy and cervical lesions, evaluate the diagnostic value of electronic colposcopy for cervical lesions, and discuss its clinical significance. Methods: the general data and colposcopy images of 863 patients who underwent colposcopy examination and biopsy from January 2011 to August 2013 in gynecological outpatient department of the first affiliated Hospital of Dalian Medical University were analyzed retrospectively. The colposcopy diagnosis was compared with the pathological diagnosis of biopsy or operation. Results: under colposcopy, 863 cases were examined and biopsy, 459 cases of CINI were diagnosed as normal / chronic cervicitis under colposcopy, 127 cases of CINII were diagnosed as CINII, and 103 cases of CINIII were detected. Pathological results showed that 523 cases of normal / chronic cervicitis had CINI (132 cases) and 100 cases of CINIII (108 cases). The overall coincidence rate between colposcopy and pathological diagnosis was 83.31. The overall diagnostic coincidence rate of colposcopy for cervical lesions was 71.78, the sensitivity was 85.299.29, the specificity was 79.01, the false positive rate was 20.99, and the false negative rate was 14.71. The diagnostic coincidence rate for CINI was 60.92, the sensitivity was 80.30, the specificity was 90.70, the false positive rate was 9.30 and the false negative rate was 19.70.The diagnostic coincidence rate for CINII-III was 80.00,88.46 and the specificity was 94.666.The false positive rate was 5.34and the false negative rate was 11.54B. There was a high consistency between the results of colposcopy and pathological diagnosis. The diagnostic coincidence rate, sensitivity and specificity of colposcopy for CINII-III were significantly higher than those for CINI (P < 0.05). Conclusion: colposcopy has important application value in the diagnosis of cervical lesions, the appearance of dense white acetate epithelium, mosaic and white spot under colposcopy means that the possibility of high grade lesions is high, and we should be on high alert. The rate of overdiagnosis of low grade lesions (鈮

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