Tatiyachonwiphut Molpen, Jaishuen Atthapon, Sangkarat Suthi, Laiwejpithaya Somsak, Wongtiraporn Weerasak, Inthasorn Perapong, Viriyapak Boonlert, Warnnissorn Malee
Department of Obstetrics and Gynaecology, Gynaecologic Oncology Unit, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand E-mail :
Asian Pac J Cancer Prev. 2014;15(1):423-6. doi: 10.7314/apjcp.2014.15.1.423.
To evaluate the agreement between colposcopic diagnosis and cervical pathology a retrospective chart review was performed.
This study included 437 patients who underwent colposcopy and cervical biopsy or conization at Siriraj Hospital from October 2010 - December 2012. The patient clinical characteristics, cervical cytology results, colposcopic diagnoses, cervical pathology results were recorded and correlations between variables were analyzed.
Agreement of colposcopic diagnosis and cervical pathology was matched in 253 patients (57.9%). The strength of agreement with weighted Kappa statistic was 0.494 (p<0.001). Colposcopic diagnoses more often overestimated (31.1%) than underestimated (11%) the cervical pathology. Agreement of colposcopic diagnosis and cervical pathology within 1 grade was found in 411 patients (94.1%). Positive predictive value (PPV) of high grade colposcopy or more was 75.5%, whereas the negative predictive value (NPV) of insignificant and low grade colposcopy was 83.8%. False positives of high grade colposcopy or more were 21%. False negatives of insignificant or low grade colposcopy were 19.1%.
Strength of agreement between colposcopic diagnosis and cervical pathology was found to be only moderate. A biopsy at colposcopy should be performed at a gold standard level to detect high grade lesions.
为评估阴道镜诊断与宫颈病理之间的一致性，进行了一项回顾性病历审查。
本研究纳入了2010年10月至2012年12月在诗里拉吉医院接受阴道镜检查及宫颈活检或锥切术的437例患者。记录患者的临床特征、宫颈细胞学检查结果、阴道镜诊断、宫颈病理结果，并分析变量之间的相关性。
253例患者（57.9%）的阴道镜诊断与宫颈病理结果相符。加权Kappa统计量的一致性强度为0.494（p<0.001）。阴道镜诊断高估宫颈病理结果的情况（31.1%）比低估（11%）更为常见。411例患者（94.1%）的阴道镜诊断与宫颈病理结果在1个级别内相符。高级别或更高级别阴道镜检查的阳性预测值（PPV）为75.5%，而意义不显著及低级别阴道镜检查的阴性预测值（NPV）为83.8%。高级别或更高级别阴道镜检查的假阳性率为21%。意义不显著或低级别阴道镜检查的假阴性率为19.1%。
发现阴道镜诊断与宫颈病理之间的一致性强度仅为中等。阴道镜检查时应按照金标准水平进行活检，以检测高级别病变。
