Ruan Yetian, Liu Min, Guo Junhan, Zhao Junwei, Niu Sumei, Li Fang
Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, China.
Arch Gynecol Obstet. 2020 Dec;302(6):1529-1538. doi: 10.1007/s00404-020-05740-x. Epub 2020 Aug 17.
The primary aim of this study was to evaluate the diagnostic accuracy of colposcopy in identifying high-grade squamous intraepithelial lesion or worse (HSIL+) and the characteristic performance of colposcopic images with various severity levels of cervical lesions.
The medical records from 1828 women who underwent colposcopy at Affiliated Hospital of Tongji University from February 2016 to March 2019 were reviewed. Human papilloma virus (HPV) GenoArray test kit (HybriBio Ltd) and Thinprep cytologic test (TCT, Hologic, USA) were used to perform HPV genotyping and cytology. All colposcopic images were collected from the standard-of-care colposcope (Leisegang 3ML LED) and evaluated based on the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) Colposcopy Standards. The linear by linear association, Pearson χ test, χ test, Kappa test, McNemar test and risk test were used to perform statistical analyses.
The consistency between colposcopy and biopsy pathology was 59.35% with the moderate strength of kappa coefficient of 0.464. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of colposcopy and cytology for HSIL+ were 56.29%, 93.82%, 77.47%, 85.04% and 37.13%, 98.49%, 90.29%, 80.58%, respectively. The colposcopic features of HSIL+ were as follows: (1) thick or bulgy acetowhite epithelium with sharp border; (2) completely nonstained of Lugol's iodine; (3) type III/IV/V of gland openings; (4) punctation or atypical vessels.
The data and findings herein provide the resource for evaluating the diagnostic value of colposcopy, and suggested that the accuracy of colposcopy is required to be further improved.
本研究的主要目的是评估阴道镜检查在识别高级别鳞状上皮内病变或更严重病变（HSIL+）方面的诊断准确性，以及不同严重程度宫颈病变的阴道镜图像特征表现。
回顾了2016年2月至2019年3月在同济大学附属同济医院接受阴道镜检查的1828名女性的病历。使用人乳头瘤病毒（HPV）基因芯片检测试剂盒（HybriBio Ltd）和薄层液基细胞学检测（TCT，美国Hologic公司）进行HPV基因分型和细胞学检查。所有阴道镜图像均采集自标准护理阴道镜（Leisegang 3ML LED），并根据2011年国际宫颈病理与阴道镜联合会（IFCPC）阴道镜检查标准进行评估。采用线性与线性关联、Pearson χ检验、χ检验、Kappa检验、McNemar检验和风险检验进行统计分析。
阴道镜检查与活检病理的一致性为59.35%，kappa系数为中等强度，为0.464。阴道镜检查和细胞学检查对HSIL+的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为56.29%、93.82%、77.47%、85.04%和37.13%、98.49%、90.29%、80.58%。HSIL+的阴道镜特征如下：（1）醋酸白上皮增厚或隆起，边界清晰；（2）卢戈氏碘完全不着色；（3）腺开口为III/IV/V型；（4）点状或非典型血管。
本文的数据和研究结果为评估阴道镜检查的诊断价值提供了参考，并表明阴道镜检查的准确性有待进一步提高。
