光学相干断层扫描在宫颈癌及癌前病变早期诊断中的临床价值：一项横断面研究
Clinical value of optical coherence tomography in the early diagnosis of cervical cancer and precancerous lesions: a cross-sectional study.
作者信息
Cui Xiaoli, Yang Di, Zhang Jing, Zhao Yuqian, Cui Zhumei, Wang Chunyan, Qiao Youlin
机构信息
Department of Gynecologic Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China.
Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science & Technology of China, Chengdu, Sichuan, China.
出版信息
Front Oncol. 2024 Jul 29;14:1423128. doi: 10.3389/fonc.2024.1423128. eCollection 2024.
BACKGROUND
This study aimed to measure the accuracy of optical coherence tomography (OCT) in the early diagnosis of high-grade cervical lesions and assess its diagnostic value in the triage of high-risk HPV infection.
METHOD
From Jan 2019 to Jan 2021, women who visited the gynecology clinics of 2 hospitals for colposcopy were invited to participate in this study. Women aged 35 to 64 years old who were sexually active and had an intact cervix with a diameter of more than or equal to 2 cm were included in this study. Additionally, individuals with abnormal cytology, positive HPV test results, or other clinically suspicious symptoms or signs were referred. All participants were examined before colposcopy using OCT. Biopsy and/or ECC were conducted under colposcopy. We used the results of histopathology as the gold standard and assessed the accuracy of OCT.
RESULTS
Overall, 883 women were included in the analysis. Approximately 13.25% of women were ASCUS+ in cytological assessments, and 22.31% were positive for high-risk HPV. Nearly 15.18% of women were positive in OCT. Of them, 27 women were diagnosed with CIN2, and 33 were diagnosed with CIN3+ lesions. Among HPV-positive women, the detection rates for CIN2+ and CIN3+ were much lower for those who were negative in OCT, compared with NILM cytology (CIN2+: 20.0% vs. 30.0%, =0.002, and CIN3+: 18.2% vs. 27.3%, =0.013). Among women who were positive for HPV16/18, the detection rate for CIN2+ was much lower for negative OCT, compared with NILM cytology (8.3% vs.15.0%, =0.005). Compared to HPV and cytological tests, HPV combined with OCT had higher specificity for detecting CIN2+ and CIN3+ (96.1% vs. 93.2%, =0.002; 93.8% vs. 91.3%, =0.013). OCT triage after HPV genotyping had the highest AUC for detecting CIN2+ and CIN3+ cases among patients with high-risk HPV infection (0.921, 0.920).
CONCLUSION
OCT is an accurate test for the early diagnosis of high-grade cervical lesions and has great diagnostic value in the triage of patients with high-risk HPV infection.
背景
本研究旨在测量光学相干断层扫描（OCT）在高级别宫颈病变早期诊断中的准确性，并评估其在高危型人乳头瘤病毒（HPV）感染分流中的诊断价值。
方法
2019年1月至2021年1月，邀请到两家医院妇科门诊接受阴道镜检查的女性参与本研究。纳入年龄在35至64岁之间、有性生活且宫颈完整、直径大于或等于2厘米的女性。此外，细胞学异常、HPV检测结果阳性或有其他临床可疑症状或体征的个体也被纳入。所有参与者在阴道镜检查前均接受OCT检查。在阴道镜下进行活检和/或宫颈管搔刮术（ECC）。我们将组织病理学结果作为金标准，并评估OCT的准确性。
结果
总体而言，883名女性纳入分析。在细胞学评估中，约13.25%的女性为意义不明确的非典型鳞状细胞（ASCUS）及以上，22.31%的女性高危型HPV检测呈阳性。近15.18%的女性OCT检查呈阳性。其中，27名女性被诊断为宫颈上皮内瘤变2级（CIN2），33名女性被诊断为CIN3及以上病变。在HPV阳性女性中，OCT检查阴性者的CIN2及以上和CIN3及以上病变的检出率远低于正常细胞学（NILM）者（CIN2及以上：20.0%对30.0%，P=0.002；CIN3及以上：18.2%对27.3%，P=0.013）。在HPV16/18阳性女性中，OCT检查阴性者的CIN2及以上病变检出率远低于NILM细胞学（8.3%对15.0%，P=0.005）。与HPV和细胞学检测相比，HPV联合OCT检测CIN2及以上和CIN3及以上病变具有更高的特异性（96.1%对93.2%，P=0.002；93.8%对91.3%，P=0.013）。在高危型HPV感染患者中，HPV基因分型后进行OCT分流检测CIN2及以上和CIN3及以上病例的曲线下面积（AUC）最高（分别为0.921、0.920）。
结论
OCT是高级别宫颈病变早期诊断的准确检测方法，在高危型HPV感染患者的分流中具有重要诊断价值。
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