Gage Julia C, Hanson Vivien W, Abbey Kim, Dippery Susan, Gardner Susi, Kubota Janet, Schiffman Mark, Solomon Diane, Jeronimo Jose
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
Obstet Gynecol. 2006 Aug;108(2):264-72. doi: 10.1097/01.AOG.0000220505.18525.85.
To examine the influence that type of medical training and number of biopsies have on sensitivity of colposcopically guided biopsies.
Among 408 women with an adequate enrollment colposcopy and a diagnosis of cervical intraepithelial neoplasia (CIN) 3 or cancer (CIN 3+) over 2 years in the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions (ASCUS-LSIL) Triage Study, we evaluated factors influencing the sensitivity of the enrollment colposcopic procedure. We used contingency table analysis to examine confounding variables and chi(2) tests to ascertain statistical significance.
Overall, 69.9% of women with a cumulative diagnosis of CIN 3+ had a "true-positive" enrollment colposcopically guided biopsy result of CIN 2 or worse (CIN 2+), the threshold that would trigger excisional therapy. The sensitivity of the procedure did not vary significantly by type of colposcopist. However, the sensitivity was significantly greater when the colposcopists took two or more biopsies instead of one (P<.01), a pattern observed across all types of colposcopists. Independent of the severity of the colposcopic impression, the frequency with which colposcopists took two or more biopsies instead of one varied (in descending order) from nurse practitioners to general gynecologists to gynecologic oncology fellows to gynecologic oncologists (P<.01).
Colposcopy with guided biopsy or biopsies detects approximately two thirds of CIN 3+. Although the sensitivity of the procedure does not differ significantly by type of medical training, it is greater when two or more biopsies are taken.
探讨医学培训类型和活检次数对阴道镜引导下活检敏感性的影响。
在非典型鳞状细胞意义不明确/低级别鳞状上皮内病变（ASCUS-LSIL）分流研究中，对408例在2年期间接受了充分的阴道镜检查且诊断为宫颈上皮内瘤变3级（CIN 3）或癌症（CIN 3+）的女性，我们评估了影响初次阴道镜检查程序敏感性的因素。我们使用列联表分析来检查混杂变量，并使用卡方检验来确定统计学意义。
总体而言，累计诊断为CIN 3+的女性中，69.9%的初次阴道镜引导下活检结果为CIN 2或更严重（CIN 2+），这是触发切除性治疗的阈值，即“真阳性”。该程序的敏感性在不同类型的阴道镜检查医师之间没有显著差异。然而，当阴道镜检查医师进行两次或更多次活检而不是一次时，敏感性显著更高（P<0.01），这一模式在所有类型的阴道镜检查医师中均有观察到。与阴道镜印象的严重程度无关，阴道镜检查医师进行两次或更多次活检而不是一次的频率（从高到低）依次为执业护士、普通妇科医生、妇科肿瘤学住院医师、妇科肿瘤学家（P<0.01）。
阴道镜引导下活检可检测出约三分之二的CIN 3+。虽然该程序的敏感性在医学培训类型上没有显著差异，但进行两次或更多次活检时敏感性更高。
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