摘要 目的研究子宫颈病变发病过程中异常细胞增殖和新生血管形成与阴道镜成像的相关性,探讨子宫颈红区在阴道镜诊断中的价值。方法收集2019年10月至2020年1月在北京大学第一医院行阴道镜检查并采用R-way阴道镜诊断术语进行描述和阴道镜拟诊的202例病例,对年龄、细胞学和高危型人乳头瘤病毒筛查结果、阴道镜图像及子宫颈组织病理结果进行统计学分析。结果仅红区无其他特征的阴道镜图像以病理组织学低级别鳞状上皮内病变(LSIL,26/70)为最多;红区+厚醋白阴道镜图像以病理组织学子宫颈上皮内瘤变(CIN)2为最多(26/58);红区+厚醋白+异型血管阴道镜图像以病理组织学CIN3为最多(17/29);红区中增生与出血伴随出现的阴道镜图像病理组织学均为子宫颈癌(8/8),以上差异均有统计学意义(P<0.05),其他类别阴道镜图像的病理组织类型分布差异无统计学意义(P>0.05);以红区为基础的各类阴道镜图像共识别出60.89%(123/202)的高级别鳞状上皮内病变(HSIL)+,其中识别HSIL+特异度最高的图像为红区+增生+出血(100%),其次是红区+厚醋白+异型血管(96.2%),依据R-way阴道镜诊断标准在红区基础上结合增生伴出血、醋白、异型血管、出血等图像识别HSIL+的累积灵敏度为100%;仅红区阴道镜图像联合高级别异常细胞学的曲线下面积(AUC)(0.45)大于仅红区(0.31)。结论阴道镜检查中,多幅图像叠加分析可增加诊断的准确性;子宫颈红区具有重要诊断价值,应作为阴道镜拟诊高级别病变的必备条件;阴道镜检查未见明显异常时应结合高级别异常细胞学结果在红区活检,以降低漏诊率。 Objective colposcopy image during the cervical pathogenesis,the value of the red zone enriched by cervical blood vessels in the colposcopy diagnosis was discussed.Methods diagnosed with R-way colposcopy diagnostic terms,were collected from October 2019 to January 2020 in Peking University First Hospital. The results of age, cytology, high-risk human papillomavirus, colposcopy images and cervical histopathological results were statistically analyzed.Results colposcopy images only with red zone without other features.The colposcopy histopathology with hyperplasia and hemorrhage in the red zone was cervical cancer(8/8).The red zone+ thick acetowhite+heteromorphic vascular colposcopy histopathology was dominated by CIN3(17/29). The histology of red zone+thick acetowhite colposcopy image was CIN2(26/58)as the most.The above differences were statistically significant(P<0.05).There was no statistical difference in the pathological distribution of other colposcopy images(P>0.05).A total of 60.89%(123/202)of HSIL+ was identified by various colposcopy images based on the red zone,the image with the highest specificity for HSIL+ recognition was red zone+hyperplasia+hemorrhage(100%).It was followed byred zone + thick acetowhite + heteromorphic vessels(96.2%). The accumulated sensitivity of red zonecombined with hyperplasia,hemorrhage,acetowhite andheteromorphic vessels according to R-way colposcopydiagnosis standard for HSIL+ was 100%.AUC of red zone colposcopy images combined with high grade abnormal cytology(0.45)was higher than that of red zone only(0.31).ConclusionIn colposcopy examination,the accuracy of diagnosis can be increased by the superposition analysis ofmultiple images.The red zone should be used as an essential condition for colposcopy to detect high-grade lesions.If noobvious abnormalities are found in colposcopy,the red zone biopsy should be combined with the results of high-gradecytology to reduce the rate of missed diagnoses.
出处 《中国实用妇科与产科杂志》 CAS CSCD 北大核心 2021年第4期474-477,共4页 Chinese Journal of Practical Gynecology and Obstetrics
基金 国家科技创新重大项目(2020AAA0105200)。
