评估阴道镜检查在高级别鳞状上皮内病变检测中的准确性：一项回顾性队列研究。
Assessing colposcopic accuracy for high-grade squamous intraepithelial lesion detection: a retrospective, cohort study.
机构信息
Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Diagnosis and Treatment for Cervical Lesions Center, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, 518028, China.
出版信息
BMC Womens Health. 2022 Jan 11;22(1):9. doi: 10.1186/s12905-022-01592-6.
BACKGROUND
Inappropriate management of high-grade squamous intraepithelial lesions (HSIL) may be the result of an inaccurate colposcopic diagnosis. The aim of this study was to assess colposcopic performance in identifying HSIL+ cases and to analyze the associated clinical factors.
METHODS
Records from 1130 patients admitted to Shenzhen Maternal and Child Healthcare Hospital from 12th January, 2018 up until 30th December, 2018 were retrospectively collected, and included demographics, cytological results, HPV status, transformation zone type, number of cervical biopsy sites, colposcopists' competencies, colposcopic impressions, as well as histopathological results. Colposcopy was carried out using 2011 colposcopic terminology from the International Federation of Cervical Pathology and Colposcopy. Logistic regression modelling was implemented for uni- and multivariate analyses. A forward stepwise approach was adopted in order to identify variables associated with colposcopic accuracy. Histopathologic results were taken as the comparative gold standard.
RESULTS
Data from 1130 patient records were collated and analyzed. Colposcopy was 69.7% accurate in identifying HSIL+ cases. Positive predictive value, negative predictive value, sensitivity and specificity of detecting HSIL or more (HSIL+) were 35.53%, 64.47%, 42.35% and 77.60%, respectively. Multivariate analysis highlighted the number of biopsies, cytology, and transformation zone type as independent factors. Age and HPV subtype did not appear to statistically correlate with high-grade lesion/carcinoma.
CONCLUSION
Evidence presented here suggests that colposcopy is only 69.7% accurate at diagnosing HSIL. Even though not all HSIL will progress into cancer it is considered pre-cancerous and therefore early identification will save lives. The number of biopsies, cytology and transformation zone type appear to be predictors of misdiagnosis and therefore should be considered during clinical consultations and by way of further research.
背景
高级别鳞状上皮内病变（HSIL）处理不当可能是阴道镜检查诊断不准确的结果。本研究旨在评估阴道镜识别 HSIL+病例的性能，并分析相关临床因素。
方法
回顾性收集了 2018 年 1 月 12 日至 2018 年 12 月 30 日期间在深圳妇幼保健院就诊的 1130 名患者的病历记录，包括人口统计学、细胞学结果、HPV 状态、转化区类型、宫颈活检部位数量、阴道镜医师的能力、阴道镜印象以及组织病理学结果。阴道镜检查采用 2011 年国际宫颈病理和阴道镜学会的阴道镜术语。采用单因素和多因素分析进行逻辑回归建模。采用逐步向前法确定与阴道镜准确性相关的变量。组织病理学结果被视为比较的金标准。
结果
共整理和分析了 1130 例患者记录的数据。阴道镜检查识别 HSIL+病例的准确率为 69.7%。检测 HSIL 或更高级别病变（HSIL+）的阳性预测值、阴性预测值、敏感性和特异性分别为 35.53%、64.47%、42.35%和 77.60%。多因素分析突出了活检数量、细胞学和转化区类型是独立因素。年龄和 HPV 亚型与高级别病变/癌似乎没有统计学相关性。
结论
本研究表明，阴道镜检查诊断 HSIL 的准确率仅为 69.7%。虽然并非所有 HSIL 都会进展为癌症，但它被认为是癌前病变，因此早期识别可以挽救生命。活检数量、细胞学和转化区类型似乎是误诊的预测因素，因此应在临床咨询和进一步研究中加以考虑。
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