基于实时阴道镜检查的阴道镜印象与静态数字图像评估的比较
Comparison of Colposcopic Impression Based on Live Colposcopy and Evaluation of Static Digital Images.
作者信息
Liu Angela H, Gold Michael A, Schiffman Mark, Smith Katie M, Zuna Rosemary E, Dunn S Terence, Gage Julia C, Walker Joan L, Wentzensen Nicolas
机构信息
1Division of Cancer Epidemiology and Genetics, National Cancer Institute; 2Tulsa Cancer Institutes and University of Oklahoma School of Community Medicine; and 3University of Oklahoma Health Sciences Center, Oklahoma City, OK.
出版信息
J Low Genit Tract Dis. 2016 Apr;20(2):154-61. doi: 10.1097/LGT.0000000000000194.
OBJECTIVE
The aim of the study was to evaluate the agreement and compare diagnostic accuracy of colposcopic impressions from live colposcopy versus evaluation of static digital images.
MATERIALS AND METHODS
Live impressions and corresponding static images obtained during colposcopy of 690 women were independently compared. Diagnostic accuracy was calculated for colposcopic impressions from both methods, varying hypothetical thresholds for colposcopically directed cervical biopsies (acetowhitening or worse, low grade or worse, high grade or worse). Stratified analyses investigated the impact of referral cytology, human papillomavirus 16 infection, and age on colposcopic impression.
RESULTS
Overall agreement between live and static colposcopic visualization was 43.0% (κ = 0.20; 95% CI = 0.14-0.26) over normal, acetowhitening, low-grade, and high-grade impressions. Classification of acetowhitening or worse impressions showed the highest agreement (92.2%; κ = 0.39; 95% CI = 0.21-0.57); both methods achieved more than 95% sensitivity for CIN 2+. Agreement between live and static colposcopic visualization was 69.3% for rating low-grade or worse impressions (κ = 0.23; 95% CI = 0.14-0.33) and 71% when rating high-grade impressions (κ = 0.33; 95% CI = 0.24-0.42). Live colposcopic impressions were more likely to be rated low grade or worse (p < .01; odds ratio = 3.5; 95% CI = 2.4-5.0), yielding higher sensitivity for CIN 2+ at this threshold than static image assessment (95.4% vs 79.8%, p < .01). Overall, colposcopic impressions were more likely rated high grade on live assessment among women referred with high-grade cytology (odds ratio = 3.3; 95% CI = 1.8-6.4), significantly improving the sensitivity for CIN 2+ (66.3% vs 48.5%, p < .01).
CONCLUSIONS
Colposcopic impressions of acetowhitening or worse are highly sensitive for identifying cervical precancers and reproducible on static image-based pattern recognition.
目的
本研究旨在评估阴道镜直视下的阴道镜印象与静态数字图像评估之间的一致性，并比较二者的诊断准确性。
材料与方法
对690名女性阴道镜检查期间获得的实时印象和相应静态图像进行独立比较。计算两种方法阴道镜印象的诊断准确性，设定不同的阴道镜引导下宫颈活检假设阈值（醋酸白变或更严重、低级别或更严重、高级别或更严重）。分层分析研究转诊细胞学、人乳头瘤病毒16感染和年龄对阴道镜印象的影响。
结果
在正常、醋酸白变、低级别和高级别印象方面，实时与静态阴道镜可视化的总体一致性为43.0%（κ=0.20；95%可信区间=0.14-0.26）。醋酸白变或更严重印象的分类显示一致性最高（92.2%；κ=0.39；95%可信区间=0.21-0.57）；两种方法对CIN 2+的敏感性均超过95%。对于低级别或更严重印象的评级，实时与静态阴道镜可视化的一致性为69.3%（κ=0.23；95%可信区间=0.14-0.33），对于高级别印象的评级一致性为71%（κ=0.33；95%可信区间=0.24-0.42）。实时阴道镜印象更有可能被评为低级别或更严重（p<0.01；优势比=3.5；95%可信区间=2.4-5.0），在此阈值下对CIN 2+的敏感性高于静态图像评估（95.4%对79.8%，p<0.01）。总体而言，在高级别细胞学转诊的女性中，实时评估时阴道镜印象更有可能被评为高级别（优势比=3.3；95%可信区间=1.8-6.4），显著提高了对CIN 2+的敏感性（66.3%对48.5%，p<0.01）。
结论
醋酸白变或更严重的阴道镜印象对识别宫颈前驱癌高度敏感，并且基于静态图像的模式识别具有可重复性。
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