Shahida S M, Mirza T T, Saleh A F, Islam M A
Department of Obs & Gynae, Mymensingh Medical College (MMC), Mymensingh, Bangladesh.
Mymensingh Med J. 2012 Apr;21(2):200-6.
This observational study was done in Colposcopy clinic of Mymensingh Medical College Hospital, to evaluate the accuracy of colposcopic assessment of pre-invasive and early cervical carcinoma comparing with the reference standard of histology, in order to evaluate the justification of colposcopic examination. This study included 227 VIA (visual inspection of cervix with application of 5% acetic acid) test positive patients, who were referred to us for colposcopic evaluation during a period of January 2011 to June 2011. Patient with clinically evident of invasive cervical carcinoma were excluded from this study. VIA test was performed again in all patients prior to systematic colposcopic examination and it was found that 72.6% patients had abnormal colposcopic findings (p<0.05). Directed punch biopsy specimen was taken only from abnormal colposcopic appearances and then it was send for histopathological examination. Records of all available biopsy results were recorded. Correlation of colposcopic impression with colposcopy guided biopsy results was compared. Among 79 colposcopically diagnosed Low-grade Squamous Intraepithelial Lesions (LSIL) or low-grade Cervical Intraepithelial Neoplasia (CIN I) cases, 22.8% cases were chronic cervicities, 69.6% were LSIL (CIN I) and 7.6% were High-grade Squamous Intraepithelial Lesions (HSIL) and among 38 HSIL(CIN II/CIN III) cases, 7.8% were found to chronic cervicities, 31.6% were LSIL and 60.5% were HSIL. Fifteen cases of colposcopically diagnosed preclinical invasive carcinoma were confirmed by histopathology (p<0.05). The rate of false positive is higher in the diagnosis of HSIL than LSIL (39 vs. 30%); on the other hand the rate of false negative was higher in LSIL (9 vs. 4.5%). The sensitivity of colposcopic diagnosis of pre-invasive cervical carcinoma was ranging from 79-82% and specificity ranged between 73-87%. Positive predictive value was 62% for HSIL and 70% for LSIL and the colposcopic accuracy was 91% and 95% for the diagnosis of LSIL and HSIL respectively. All the statistical results were 100% for the diagnosis of preclinical invasive carcinoma. This study showed that colposcopy is a valid tool for the detection of pre-invasive and early cervical carcinoma. It can be considered as a secondary testing tool for VIA positive women.
这项观察性研究在迈门辛医学院医院的阴道镜诊所进行，目的是将阴道镜对宫颈浸润前病变和早期宫颈癌的评估准确性与组织学参考标准进行比较，以评估阴道镜检查的合理性。本研究纳入了227例醋酸白试验（VIA，即应用5%醋酸对宫颈进行视诊）阳性患者，这些患者于2011年1月至2011年6月期间被转诊至我院进行阴道镜评估。临床诊断为浸润性宫颈癌的患者被排除在本研究之外。在系统阴道镜检查前，所有患者均再次进行了VIA试验，结果发现72.6%的患者有异常阴道镜表现（p<0.05）。仅从异常阴道镜表现处取定向活检标本，然后送去做组织病理学检查。记录所有可用的活检结果。比较阴道镜印象与阴道镜引导下活检结果的相关性。在79例阴道镜诊断为低级别鳞状上皮内病变（LSIL）或低级别宫颈上皮内瘤变（CIN I）的病例中，22.8%为慢性宫颈炎，69.6%为LSIL（CIN I），7.6%为高级别鳞状上皮内病变（HSIL）；在38例HSIL（CIN II/CIN III）病例中，7.8%为慢性宫颈炎，31.6%为LSIL，60.5%为HSIL。15例阴道镜诊断为临床前浸润癌的病例经组织病理学确诊（p<0.05）。HSIL诊断中的假阳性率高于LSIL（39%对30%）；另一方面，LSIL中的假阴性率更高（9%对4.5%）。阴道镜诊断宫颈浸润前癌的敏感性为79 - 82%，特异性为73 - 87%。HSIL的阳性预测值为62%，LSIL为70%，阴道镜诊断LSIL和HSIL的准确性分别为91%和95%。对于临床前浸润癌的诊断，所有统计结果均为100%。本研究表明，阴道镜是检测宫颈浸润前病变和早期宫颈癌的有效工具。它可被视为VIA阳性女性的二级检测工具。
