阴道镜诊断宫颈上皮内瘤变和宫颈癌的准确性分析

发布时间：2018-02-12 14:28

本文关键词： 宫颈癌宫颈上皮内瘤变阴道镜检查 HPV TCT　出处：《浙江大学》2015年博士论文　论文类型：学位论文

【摘要】：目的：评价阴道镜诊断宫颈上皮瘤变和宫颈癌的准确性。方法：回顾性分析2014年9月1日至2014年10月31日在我院行阴道镜检查并在直视下行活检的700例患者。采用自身对照法,对比研究阴道镜诊断与活检的病理结果,并分析高危型HPV结果、官颈细胞学结果对阴道镜诊断宫颈疾病的准确性的影响。结果：阴道镜下诊断同活检病理诊断完全符合者410例(58.6%)不完全符合者290例(41.4%),其中诊断过度的为17.7%(124/290),诊断不足的为23.7%(166/290)。高危HPV阴性者进行阴道镜检查的诊断准确率(82.4%)显著高于高危HPV阳性者(56.7%,p0.01)。在26例高危HPV阴性、细胞学ASCUS者中,无1例CIN2及以上者；19例高危HPV阴性、细胞学为LSIL者仅1例CIN2及以上者。高危HPV阳性,阴道镜诊断的总体准确性不高,特别在352例阴道镜诊断为正常者中,33例(9.4%)为CIN2及以上者。结论：阴道镜诊断高级别病变的特异度和阳性预测值较高,应行阴道镜指导下的活检,以免漏诊宫颈高级别上皮内瘤变和宫颈癌；高危HPV阴性时,阴道镜诊断正常的特异度和阳性预测值高,若细胞学为低度病变、特别是ASCUS时,可考虑避免活检；高危HPV阳性时,阴道镜诊断正常或低级别病变的准确性与细胞学结果有一定关联,但细胞学检查结果尚不足以分流是否活检。
[Abstract]:Objective:. To evaluate the accuracy of colposcopy in the diagnosis of cervical epithelioma and cervical carcinoma. Methods:. A retrospective analysis of 700 patients who underwent colposcopy from September 1st 2014 to October 31st 2014 and biopsy under direct vision was performed. The pathological results of colposcopy diagnosis and biopsy were compared by self-control method. The effect of high-risk HPV and cervical cytology on the accuracy of colposcopy in the diagnosis of cervical diseases was analyzed. Results:. Under colposcopy, 410 cases (58.6%) were completely consistent with pathological diagnosis of biopsy. (290 cases (41.4%) were not fully consistent with the pathological diagnosis. Among them, 17.7% of them were overdiagnosed, 12.4% of them were overdiagnosed, and 23.76% -290% of them were underdiagnosed. The diagnostic accuracy rate of colposcopy in high-risk HPV negative patients was 82.4%). In patients with high risk HPV positive, 56.7% and p0.01%. In 26 cases, high risk HPV was negative. Of the patients with cytologic ASCUS, none of them had CIN2 or more than 19 cases with high risk HPV negative, while only 1 case with cytology of LSIL was CIN2 or above. The high risk HPV was positive, and the overall accuracy of colposcopy diagnosis was not high. Especially in 352 cases of colposcopy diagnosed as normal, 33 cases were diagnosed as CIN2 or above. Conclusion:. The specificity and positive predictive value of colposcopy in the diagnosis of high grade lesions are high. Biopsy under the guidance of colposcopy should be performed to avoid the missed diagnosis of cervical intraepithelial neoplasia and cervical cancer. Colposcopy diagnosis of normal specificity and positive predictive value is high, if cytology is low-grade lesions, especially ASCUS, you can consider avoiding biopsy, high-risk HPV positive, The accuracy of colposcopy in the diagnosis of normal or low grade lesions was correlated with cytological results, but the cytological results were not sufficient for shunt biopsy.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R737.33

【共引文献】