De Sutter P h, Coibion M, Vosse M, Hertens D, Huet F, Wesling F, Wayembergh M, Bourdon C, Autier P h
Department of Gynaecology and Obstetrics, Colposcopy Clinic, Akademisch Ziekenhuis Vrije Universiteit Brussel, Belgium.
Br J Obstet Gynaecol. 1998 Jun;105(6):613-20.
To evaluate in a multicentre setting the performance of cervicography compared with cytology for the detection of cervical intraepithelial neoplasia.
Prospective comparative multicentre study.
Three hospitals with outpatient gynaecology clinics and three cancer screening clinics.
Cervical cytology and cervicography were performed on 5724 women. If one or both tests showed an abnormality suggestive of at least a low grade squamous intraepithelial lesion, a colposcopy with directed biopsy was carried out. Cervicograms were evaluated by four experienced 'senior' assessors and by ten new 'junior' assessors.
Results were fully analysed for 5192 women (91%). A cervical biopsy was carried out on 228 women and this confirmed a true positive lesion in 116 cases (incidence rate: 2.2%). Of these, 72 cases (62.1%) were detected by cervicography and 64 (55.2%) by cytology. This difference was not statistically significant (McNemar: P=0.475). Only 20 cases of CIN (17%) were concordantly detected by both tests. Senior assessors performed significantly better with a detection capacity of 80.6% compared to a detection capacity of 56.6% for the junior assessors (chi2 test: P=0.034).
Cervicography must be considered as a complementary test to cytology. Overall detection of CIN is improved, but this is mainly due to the detection of more low grade lesions. The lower sensitivity and specificity in high grade lesions compared with cervical cytology is the main limitation of cervicography in screening for CIN. An important finding was that the performance of cervicography was highly dependent on the assessors' experience.
在多中心环境中评估宫颈图像分析术与细胞学检查在检测宫颈上皮内瘤变方面的性能。
前瞻性比较多中心研究。
三家设有妇科门诊的医院和三家癌症筛查诊所。
对5724名女性进行了宫颈细胞学检查和宫颈图像分析术。如果一项或两项检查显示异常，提示至少为低级别鳞状上皮内病变，则进行阴道镜检查及定向活检。宫颈图像由四名经验丰富的“资深”评估员和十名新的“初级”评估员进行评估。
对5192名女性（91%）的结果进行了全面分析。对228名女性进行了宫颈活检，其中116例（发病率：2.2%）确诊为真正的阳性病变。其中，72例（62.1%）通过宫颈图像分析术检测到，64例（55.）通过细胞学检查检测到。这一差异无统计学意义（麦克尼马尔检验：P = 0.475）。两项检查仅一致检测出20例CIN（17%）。资深评估员的表现明显更好，检测能力为80.6%，而初级评估员的检测能力为56.6%（卡方检验：P = 0.034）。
宫颈图像分析术必须被视为细胞学检查的补充检查。CIN的总体检测率有所提高，但这主要是由于检测出了更多的低级别病变。与宫颈细胞学检查相比，高级别病变中较低的敏感性和特异性是宫颈图像分析术在CIN筛查中的主要局限性。一个重要发现是，宫颈图像分析术的性能高度依赖于评估员的经验。
