Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Obstetrics and Gynecology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
BMC Cancer. 2024 Mar 26;24(1):381. doi: 10.1186/s12885-024-12156-2.
Inaccurate colposcopy diagnosis may lead to inappropriate management and increase the incidence of cervical cancer. This study aimed to evaluate the diagnostic accuracy of colposcopy in the detection of histologic cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in women with transformation zone type 3 (TZ3).
Records from 764 patients with TZ3 who underwent colposcopy-directed biopsy and/or endocervical curettage in Putuo Hospital China between February 2020 and March 2023 were retrospectively collected. Colposcopy was carried out based on 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) and Colposcopy nomenclature. The diagnostic performance of colposcopy for identifying CIN2 + was evaluated compared with biopsies. The Kappa and McNemar tests were used to perform statistical analyses.
Among the study population, 11.0% had pathologic CIN2+. The relative sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of colposcopy for histologic CIN2 + were 51.2%, 96.5%, 64.2% and 94.1%, respectively. The senior colposcopists (80.6%) had a higher colposcopic accuracy to diagnose histologic CIN2 + than junior colposcopists (68.6%). In subgroup analyses, age group ≥ 60 years (70.3%) showed lowest diagnostic accuracy when compared with age groups of < 45 years (84.4%) and 45-59 years (74.9%).
Our findings suggest an increased risk of diagnostic inaccuracy of colposcopy in identifying CIN2 + in those ≥ 60 years of age with TZ3, and the accuracy of colposcopy is required to be further improved.
不准确的阴道镜检查可能导致不适当的管理，并增加宫颈癌的发病率。本研究旨在评估阴道镜检查在诊断转化区 3 型（TZ3）女性组织学宫颈上皮内瘤变 2 级或更高级别（CIN2+）中的诊断准确性。
回顾性收集了 2020 年 2 月至 2023 年 3 月期间在中国普陀医院接受阴道镜指导下活检和/或宫颈管搔刮术的 764 例 TZ3 患者的病历。阴道镜检查基于 2011 年国际宫颈病理和阴道镜学会（IFCPC）和阴道镜命名法进行。评估阴道镜对 CIN2+的诊断性能，并与活检进行比较。使用 Kappa 和 McNemar 检验进行统计学分析。
研究人群中，11.0%的患者存在组织学 CIN2+。阴道镜对组织学 CIN2+的相对灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 51.2%、96.5%、64.2%和 94.1%。高级阴道镜医师（80.6%）对组织学 CIN2+的阴道镜诊断准确性高于初级阴道镜医师（68.6%）。在亚组分析中，年龄组≥60 岁（70.3%）的诊断准确性最低，而年龄组<45 岁（84.4%）和 45-59 岁（74.9%）的诊断准确性较高。
我们的研究结果表明，阴道镜检查在识别 TZ3 中≥60 岁的 CIN2+患者时存在诊断准确性增加的风险，需要进一步提高阴道镜的准确性。
