细胞学及阴道镜检查对宫颈病变的诊断价值

目的评价细胞学及阴道镜检查对宫颈病变的诊断价值。方法以宫颈环型电切术(LEEP)后病理诊断为标准,对照分析巴氏涂片、液基薄层细胞检测(TCT)、阴道镜、细胞学联合阴道镜检查对400例患者宫颈病变的筛查结果。结果巴氏涂片灵敏度64.9%,特异度85.4%,假阴性率35.1%,假阳性率14.6%;TCT灵敏度77.8%,特异度80.7%,假阴性率22.2%,假阳性率19.3%;阴道镜灵敏度92.5%,特异度74.3%,假阴性率7.5%,假阳性率25.7%;阴道镜诊断不足19例(8.2%),诊断过度54例(23.2%);细胞学联合阴道镜灵敏度92.9%,特异度64.1%,假阴性率7.1%,假阳性率35.9%。巴氏涂片与TCT的检出率比较,差异无统计学意义(P>0.05);阴道镜和细胞学联合阴道镜检查的检出率明显高于细胞学检查(P<0.05)。结论细胞学联合阴道镜检查是较为理想的宫颈病变筛查方法,阴道镜诊断宫颈病变仍存在一定的漏诊率,尚无法代替LEEP。

Value of cervical cytologic tests and colposcopy in diagnosis of cervical lesions

Objective To evaluate the diagnostic value of cervical cytology and colposcopy in the diagnosis of cervical lesions. Methods The results of Pap smear,ThinPrep cytologic test(TCT),colposcopy and combined examination of cytology and colposcopy were determined according to the pathological outcomes of loop electrosurgical excision procedure(LEEP) in 400 samples. Results The sensitivity,specificity,false-negative rate and false-positive rate of Pap smear were 64.9%,85.4%,35.1%,and 14.6%,respectively,and those of TCT were 77.8%,80.7%,22.2% and 19.3%,respectively,colposcopy 92.5%,74.3%,7.5% and 25.7%,respectively,and combined examination of cytology and colposcopy 92.9%,64.1%,7.1% and 35.9%,respectively.The underdiagnosis rate and overdiagnosis rate of colposcopy were 8.2%(n=19) and 23.2%(n=54),respectively.There was no significant difference in the detection rate between Pap smear and TCT(P>0.05),and the detection rate of colposcopy and combined examination of cytology and colposcopy was significantly higher than that of cytologic examination(P<0.05). Conclusion The combination of cytology and colposcopy may be a most effective method in screening of cervical lesions.There exists certain rate of missed diagnosis for colposcopy,and it can not take place of cervical LEEP.