光学相干断层扫描在阴道镜检查前对宫颈细胞学轻度异常的女性进行分诊的效果。
Efficacy of optical coherence tomography in the triage of women with minor abnormal cervical cytology before colposcopy.
机构信息
Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
出版信息
PLoS One. 2023 Mar 13;18(3):e0282833. doi: 10.1371/journal.pone.0282833. eCollection 2023.
OBJECTIVES
To evaluate the efficacy of Optical Coherence Tomography (OCT) for detecting cervical lesions in women with minor abnormal cytology results (atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL)).
METHODS
A prospective study was conducted at gynecologic clinic from Mar 2021 to Sep 2021. The recruited women with cervical cytological findings of ASC-US or LSIL were inspected with OCT before colposcopy-directed cervical biopsy. The diagnostic performance of OCT, alone and in combination with high-risk human papillomavirus (hrHPV) testing were evaluated to detect cervical intraepithelial neoplasia of grade 2 or worse (CIN2+)/CIN3 or worse (CIN3+). The rate of colposcopy referral and the immediate risk of CIN3+ of OCT were calculated.
RESULTS
A total of 349 women with minor abnormal cervical cytology results were enrolled. For detection of CIN2+/CIN3+, the sensitivity and NPV of OCT were lower than those of hrHPV testing (CIN2+: 71.3% vs. 95.4%, 89.0% vs. 91.1%, P < 0.001; CIN3+: 75% vs. 93.8%, 96.5% vs. 95.6%, P < 0.001), but the specificity, accuracy and PPV were higher than those of hrHPV testing (CIN2+: 77.5% vs. 15.6%, 75.9% vs. 35.5%, 51.2% vs. 27.3%, P < 0.001; CIN3+: 69.4% vs. 13.6%, 69.9% vs. 20.9%, 19.8% vs. 9.9%, P < 0.001). OCT combined with hrHPV testing (CIN2+: 80.9%; CIN3+: 72.6%) showed higher specificity than that of OCT alone (P < 0.001). The colposcopy referral rate base on OCT classification was lower than that based on hrHPV testing (34.7% vs. 87.1%, P < 0.001). Patients with hrHPV-positive ASC-US and hrHPV-negative LSIL cytology, the immediate CIN3+ risk in OCT negative cases was less than 4%.
CONCLUSIONS
OCT alone or combination with hrHPV testing shows good performance for detecting CIN2+/CIN3+ in patients with ASC-US/LSIL cytology. OCT is an effective method for colposcopy triage in women with hrHPV-positive ASC-US and hrHPV-negative LSIL cytology.
目的
评估光学相干断层扫描（OCT）检测细胞学异常结果（不明确意义的非典型鳞状细胞（ASC-US）和低级别鳞状上皮内病变（LSIL））女性宫颈病变的疗效。
方法
本前瞻性研究于 2021 年 3 月至 2021 年 9 月在妇科诊所进行。对宫颈细胞学检查发现 ASC-US 或 LSIL 的女性进行 OCT 检查，然后行阴道镜指导下宫颈活检。评估 OCT 单独及与高危型人乳头瘤病毒（hrHPV）检测联合应用检测 2 级或更高级别宫颈上皮内瘤变（CIN2+/CIN3+）/3 级或更高级别宫颈上皮内瘤变（CIN3+）的诊断性能。计算阴道镜转诊率和 OCT 即刻 CIN3+风险。
结果
共纳入 349 例细胞学异常的女性。对于 CIN2+/CIN3+的检测，OCT 的敏感性和阴性预测值均低于 hrHPV 检测（CIN2+：71.3%比 95.4%，89.0%比 91.1%，P<0.001；CIN3+：75%比 93.8%，96.5%比 95.6%，P<0.001），但特异性、准确性和阳性预测值均高于 hrHPV 检测（CIN2+：77.5%比 15.6%，75.9%比 35.5%，51.2%比 27.3%，P<0.001；CIN3+：69.4%比 13.6%，69.9%比 20.9%，19.8%比 9.9%，P<0.001）。OCT 联合 hrHPV 检测（CIN2+：80.9%；CIN3+：72.6%）显示出比 OCT 单独检测更高的特异性（P<0.001）。基于 OCT 分类的阴道镜转诊率低于基于 hrHPV 检测（34.7%比 87.1%，P<0.001）。对于 hrHPV 阳性的 ASC-US 和 hrHPV 阴性的 LSIL 细胞学患者，OCT 阴性病例的即刻 CIN3+风险小于 4%。
结论
OCT 单独或联合 hrHPV 检测对 ASC-US/LSIL 细胞学患者检测 CIN2+/CIN3+具有良好的性能。对于 hrHPV 阳性的 ASC-US 和 hrHPV 阴性的 LSIL 细胞学患者，OCT 是一种有效的阴道镜检查分类方法。
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