Balmagambetova Saule, Tinelli Andrea, Urazayev Olzhas, Koyshybaev Arip, Ismagulova Elnara, Sakiyeva Kanshaiym, Djussembekov Saganaj, Zholmukhamedova Dinara
Department of Oncology, West Kazakhstan Marat Ospanov Medical University, 030019, 68, Maresyev Street, Aktobe, Kazakhstan.
Laboratory of Human Physiology, Phystech Biomed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), 9, Institutskiy Lane, 141701 Dolgoprudny, Moscow Region, Russia.
Gynecol Oncol Rep. 2020 Oct 24;34:100661. doi: 10.1016/j.gore.2020.100661. eCollection 2020 Nov.
This retrospective cohort study focused on colposcopic accuracy for the diagnosis of cervical premalignant lesions using cytology and histology, as well as HPV data not included in current cervical screening practices in Kazakhstan. Colposcopy performance was assessed using the modified Reid index in women aged 18-63 years. In total, 1,129 colposcopic-HPV-cytology triple samples and 94 histology findings were collected. The sensitivity of colposcopy was 81.6% with specificity 72.6% for LSIL but fell to 56.6% with specificity 88.3% for CIN2+ vs. 89.6% and 74.5% for cytology at CIN2+, respectively. The ORs for high-grade lesion occurrence within each colposcopy group at viral load rising vs. ORs for HPV-negative women were 3.4; 5.3; and 39.7, respectively (p < 0.0001). Total attributive agreement between the colposcopy and histology findings reached 55.3%, κ 0.47 ± 0.06 vs. 0.62 ± 0.08 for cytology, and 0.34 ± 0.13 and 0.58 ± 0.1, for specialists, respectively. Outcomes obtained for colposcopy alone failed to show satisfactory reliability. Globally adopted primary HPV screening would be the best option despite the related costs.
这项回顾性队列研究聚焦于阴道镜检查在利用细胞学和组织学诊断宫颈前病变方面的准确性，以及哈萨克斯坦当前宫颈筛查实践中未纳入的人乳头瘤病毒（HPV）数据。采用改良的里德指数对18至63岁女性的阴道镜检查表现进行评估。总共收集了1129份阴道镜-HPV-细胞学三联样本和94份组织学检查结果。阴道镜检查对低度鳞状上皮内病变（LSIL）的敏感性为81.6%，特异性为72.6%，但对高级别宫颈上皮内瘤变2级及以上（CIN2+）的敏感性降至56.6%，特异性为88.3%，而CIN2+时细胞学检查的敏感性和特异性分别为89.6%和74.5%。病毒载量上升时，各阴道镜检查组内高级别病变发生的比值比（OR）与HPV阴性女性的比值比分别为3.4、5.3和39.7（p<0.0001）。阴道镜检查结果与组织学检查结果的总体归因一致性达到55.3%，κ值为0.47±0.06，而细胞学检查的κ值为0.62±0.08，专家检查的κ值分别为0.34±0.13和0.58±0.1。仅阴道镜检查获得的结果未能显示出令人满意的可靠性。尽管存在相关成本，但全球采用的主要HPV筛查仍是最佳选择。
