Ye Zichen, Cui Xiaoli, Wang Huike, Chen Mingyang, Lu Qu, Jiang Yu, Xue Peng, Qiao Youlin
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Gynecologic Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China.
J Low Genit Tract Dis. 2025 Jan 1;29(1):6-12. doi: 10.1097/LGT.0000000000000838. Epub 2024 Oct 10.
The value of the transformation zone (TZ) is often overlooked in clinical settings. This study aims to assess TZ distribution, associated factors, and its impact on colposcopic diagnosis.
χ 2 tests were used to analyze demographics, clinical history, and tissue samples to examine the differences in TZ distribution. Factors affecting the TZ were explored using logistic regression, and diagnostic indicators were calculated.
A total of 5,302 individual datasets were finally included. TZ1, TZ2, and TZ3 accounted for 31.6%, 38.5%, and 30.0%, respectively. Age is the most important factor that influences the location of the TZ. The proportion of TZ3 steadily increased with age, comprising over 55% in women over 50. The colposcopic diagnostic performance shows that high-grade squamous intraepithelial lesion or worse (HSIL+) sensitivity of TZ3 (58.1%, 95% confidence interval [CI] = 52.9-63.4) is significantly lower than that of TZ1 (69.8%, 95% CI = 65.5-74.1) and TZ2 (73.2%, 95% CI = 69.7-76.8). The HSIL+ specificity of TZ3 (96.3, 95% CI = 95.3-97.4) was higher than that of TZ1 (96.3, 95% CI = 95.2-97.3) and TZ2 (92.5, 95% CI = 91.1-93.9). The HSIL+ positive predictive value (81.3%, 95% CI = 76.4-86.2) and negative predictive value (89.3%, 95% CI = 87.6-90.9) for TZ3 are high, with no significant differences when compared with TZ1 and TZ2.
Age predominantly influences TZ location, with TZ3 being most frequently found in women over 50. While TZ3 poses a higher risk of missed diagnosis during colposcopy, it remains clinically valuable in identifying diseased and nondiseased status. Increasing colposcopists' awareness of TZ importance is needed in clinical practice.
转化区（TZ）的价值在临床环境中常被忽视。本研究旨在评估TZ的分布、相关因素及其对阴道镜诊断的影响。
采用χ²检验分析人口统计学、临床病史和组织样本，以检查TZ分布的差异。使用逻辑回归探索影响TZ的因素，并计算诊断指标。
最终纳入5302个个体数据集。TZ1、TZ2和TZ3分别占31.6%、38.5%和30.0%。年龄是影响TZ位置的最重要因素。TZ3的比例随年龄稳步增加，50岁以上女性中超过55%。阴道镜诊断性能显示，TZ3的高级别鳞状上皮内病变或更严重病变（HSIL+）敏感性（58.1%，95%置信区间[CI]=52.9 - 63.4）显著低于TZ1（69.8%，95%CI = 65.5 - 74.1）和TZ2（73.2%，95%CI = 69.7 - 76.8）。TZ3的HSIL+特异性（96.3，95%CI = 95.3 - 97.4）高于TZ1（96.3，95%CI = 95.2 - 97.3）和TZ2（92.5，95%CI = 91.1 - 93.9）。TZ3的HSIL+阳性预测值（81.3%，95%CI = 76.4 - 86.2）和阴性预测值（89.3%，95%CI = 87.6 - 90.9）较高，与TZ1和TZ2相比无显著差异。
年龄主要影响TZ位置，TZ3在50岁以上女性中最常见。虽然TZ3在阴道镜检查期间漏诊风险较高，但在识别患病和未患病状态方面仍具有临床价值。临床实践中需要提高阴道镜检查人员对TZ重要性的认识。
