[2011年阴道镜检查国际术语的阴道镜诊断与宫颈病变宫颈病理学之间的一致性]

[Agreement between colposcopic diagnosis with 2011 international terminology of colposcopy and cervical pathology in cervical lesions].

作者信息

Li Yanyun, Zhang Hongwei, Zheng Ruilian, Xie Feng, Sui Long

机构信息

Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.

Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; Email:

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2015 May;50(5):361-6.

PMID:26311456

Abstract

OBJECTIVE

To evaluate the agreement between colposcopic diagnosis with 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy (IFCPC) and cervical pathology in cervical lesions.

METHODS

A retrospective cohort study was performed, which included 376 patients who underwent colposcopy with 2011 international terminology of colposcopy at Obstetrics and Gynecology Hospital of Fudan University from September 2014 to November 2014. With conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated and correlations between variables were analyzed.

RESULTS

With 2011 international terminology of colposcopy, agreement of colposcopic diagnosis and cervical pathology was 60.9% (229/376) perfectly matched, and the strength of agreement with weighted Kappa statistic was 0.401 (P < 0.01), and agreement within one grade was 97.6% (367/376), which were improved compared with traditional methods. Colposcopic diagnosis were 19.9% (75/376) overestimated and 19.1% (72/376) underestimated. There were no significant difference between agreements in various grade lesions (χ(2) = 1.996, P = 0.573). Positive predictive value of high grade colposcopy or more was 84.4%, the negative predictive value of low grade colposcopy or less was 88.8%, whereas false positives were 3.5% and false negatives were 39.3%. A linear trend among three types of transformation zone and patient ages was found (χ(2) = 45.910, P < 0.01), whereas lesion sizes were not linearly correlated with lesion degrees (χ(2) = 0.690, P = 0.406). In grade 1, grade 2 and nonspecific findings, thin acetowhite epithelium, dense acetowhite epithelium and Lugol's non-staining were most frequent, the Youden indexes of each were 0.170, 0.373 and 0.145, 0.069 respectively. Positive predictive value of some other findings (such as fine mosaic) and two new signs (inner border sign and ridge sign) were 100.0%. There were no significant difference between agreements in examiners with different levels of experience (χ(2) = 1.197, P = 0.550).

CONCLUSIONS

Compared to traditional methods (such as Reid index), 2011 international terminology of colposcopy could improve the agreement between colposcopic diagnosis and pathologic diagnosis, without significant differences by the severity of lesion and the level of examiners' experience. Common findings were classified reasonably, and some signs were highly reliable, which is important for guiding biopsy. However, the reproducibility of transformation zone types and the implication of lesion size need to be further discussed.

摘要

目的

评估采用国际宫颈病理和阴道镜检查联合会（IFCPC）2011年阴道镜术语进行的阴道镜诊断与宫颈病变的宫颈病理结果之间的一致性。

方法

进行一项回顾性队列研究，纳入2014年9月至2014年11月在复旦大学附属妇产科医院接受采用2011年国际阴道镜术语进行阴道镜检查的376例患者。以宫颈锥切术或宫颈活检病理结果作为金标准，计算阴道镜诊断与病理诊断之间的一致性，并分析变量之间的相关性。

结果

采用2011年国际阴道镜术语时，阴道镜诊断与宫颈病理结果完全匹配的一致性为60.9%（229/376），加权Kappa统计量的一致性强度为0.401（P<0.01），一级内的一致性为97.6%（367/376），与传统方法相比有所提高。阴道镜诊断高估19.9%（75/376），低估19.1%（72/376）。不同级别病变的一致性之间无显著差异（χ² = 1.996，P = 0.573）。高级别及以上阴道镜检查的阳性预测值为84.4%，低级别及以下阴道镜检查的阴性预测值为88.8%，而假阳性为3.5%，假阴性为39.3%。发现三种转化区类型与患者年龄之间存在线性趋势（χ² = 45.910，P<0.01），而病变大小与病变程度无线性相关性（χ² = 0.690，P = 0.406）。在1级、2级和非特异性表现中，薄醋酸白色上皮、致密醋酸白色上皮和卢戈氏不着色最为常见，各自的约登指数分别为0.170、0.373和0.145、0.069。其他一些表现（如细镶嵌）和两个新体征（内边界征和嵴征）的阳性预测值为100.0%。不同经验水平的检查者之间的一致性无显著差异（χ² = 1.197，P = 0.550）。