Massad L Stewart, Collins Yvonne C
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Southern Illinois University, Springfield, IL 62794, USA.
Gynecol Oncol. 2003 Jun;89(3):424-8. doi: 10.1016/s0090-8258(03)00082-9.
The aim of this study was to determine the strength of the correlation between colposcopic impression and biopsy histology.
In an urban referral clinic, colposcopy and directed biopsy were performed between July 1, 1996, and December 31, 1999, by residents supervised by board-certified attending obstetrician-gynecologists. Impression and biopsy were graded as benign, suggesting condyloma or koilocytosis, cervical intraepithelial neoplasia (CIN) grades 1-3, or cancer. The significance of association was assessed by chi(2) testing and the strength by kappa statistics.
Colposcopies were performed on 2825 women, with colposcopic impression and biopsy grade known for 2112. Exact agreement was found in only 893 (37%) women, but results agreed within one grade in 1203 (75%). The association between impression and histology was significant (P < 0.001), but the strength of the correlation was poor (0.20). The positive predictive value of any colposcopic abnormality for any histologic abnormality was 80%. The negative predictive value of a benign colposcopic impression was 68%. The sensitivity of colposcopy with a threshold of any lesion detected was 89%, and the specificity was 52%. The sensitivity for CIN 2/3 was 56%.
Colposcopy is imprecise, although useful in estimating lesion grade. Management decisions require biopsy.
本研究旨在确定阴道镜印象与活检组织学之间的关联强度。
在一家城市转诊诊所，于1996年7月1日至1999年12月31日期间，由获得委员会认证的妇产科主治医生监督住院医师进行阴道镜检查和定向活检。将印象和活检分为良性、提示尖锐湿疣或挖空细胞、宫颈上皮内瘤变（CIN）1 - 3级或癌症。通过卡方检验评估关联的显著性，通过kappa统计量评估关联强度。
对2825名女性进行了阴道镜检查，其中2112名女性的阴道镜印象和活检分级已知。仅在893名（37%）女性中发现完全一致的结果，但在1203名（75%）女性中结果在一个分级内一致。印象与组织学之间的关联具有显著性（P < 0.001），但关联强度较差（0.20）。任何阴道镜异常对任何组织学异常的阳性预测值为80%。阴道镜印象为良性的阴性预测值为68%。以检测到任何病变为阈值的阴道镜检查敏感性为89%，特异性为52%。对CIN 2/3的敏感性为56%。
阴道镜检查不够精确，尽管在估计病变分级方面有用。管理决策需要进行活检。
