云南省少数民族地区子宫颈癌筛查方式探讨

目的 探讨阴道镜在云南省少数民族地区子宫颈癌筛查中的作用.方法 收集就诊于昆明市妇幼保健院妇科门诊患者18 200 例,在知情同意基础上随机分为四组,人乳头瘤病毒(HPV)组,液基薄层细胞(TCT)组, HPV+TCT组及阴道镜检查组,前三组任何一项有异常转阴道镜活检,第四组阴道镜可疑者直接活检,比较四组方法检出阳性率及阴道镜的作用.结果 患者年龄和转化区类型存在明显的线性变化趋势(χ2回归=43.42,P<0.01).HPV阳性检出率16.79%(815/4 853),TCT阳性检出率4.25%(136/3 200),HPV联合TCT阳性检出率21.00%(882/ 4 200),阴道镜可疑检出率9.00%(535/5 947),HPV和TCT两种方法阳性检出率差异有统计学意义(χ2=291.35,P<0.05),TCT和阴道镜两种方法阳性检出率差异有统计学意义(χ2=68.94,P<0.05).TCT阳性病例活检结果是高度鳞状上皮内瘤变(HSIL)为2.19%(70/3 200),HPV联合TCT阳性病例活检结果是HSIL为2.00%(84/4 200),阴道镜可疑病例活检结果是HSIL为1.31%(78/5 947),HPV与阴道镜筛查方案检出宫颈高度病变的敏感度无明显统计学差异(χ2=1.81,P>0.05),TCT与阴道镜筛查方案检出宫颈高度病变的敏感度有明显统计学差异(χ2=10.03,P<0.05).阴道镜诊断HSIL及以上病变的敏感度为84.15%(69/82),阳性预测值为68.32%(69/101),诊断低度鳞状上皮内瘤变(LSIL)及以下病变的特异度为94.24%(524/556),阴性预测值为97.58%(524/537),假阳性率为5.76% ,假阴性率为15.85% .阴道镜与病理诊断完全符合者为397例,符合率62.23%(397/638).结论 阴道镜诊断宫颈高度病变的敏感性和特异度均较高,在云南省少数民族地区子宫颈癌机会性筛查中有重要作用,可作为一线筛查方案的补充.

Cervical cancer screening approaches in minority areas in Yunnan Province

Objective To study the role of colposcopy in cervical cancer screening in minority areas in Yunnan Province.Methods Altogether 18 200 cases receiving clinic service in gynecology department in Kunming City Maternal and Child Health Care Hospital were collected and were randomly divided into four groups with informed consent, including human papillomavirus (HPV) group, fluid based thin-layer cytological test (TCT) group, HPV+TCT group and colposcopy group.Patients in previous three groups with any suspicious lesion underwent colposcopy examination and multiple biopsy.Biopsy was directly conducted among patients in fourth group with any colposcopic suspicious lesions.Positive rate in four groups and function of colposcopy was compared.Results Age of patients and transformation zone type revealed obvious linear trend (χ2=43.42, P<0.01).Positive rate in HPV group was 16.79% (815/4 853), that in TCT group was 4.25% (136/3 200), that in TCT+HPV group was 21.00% (882/4 200), and suspicious detection rate in colposcopy group was 9.00% (535/5 947).Difference in detection rate between HPV and TCT was statistically significant (χ2=291.35, P<0.05).Difference in detection rate between TCT and colposcopy was statistically significant (χ2=68.94, P<0.05).Biopsy results of high grade squamous intraepithelial lesion (HSIL) occupied 2.19% in TCT positive cases (70/3 200).HSIL occupied 2.00% in HPV+TCT positive cases (84/4 200), and 1.31% in colposcopy suspected cases (78/5 947).There was no significant statistical difference in sensitivity between HPV and colposcopy screening of cervical lesions (χ2=1.81, P>0.05), while difference in sensitivity between TCT and colposcopy screening of cervical lesions had statistical significance (χ2=10.03, P<0.05).Sensitivity of colposcopy in diagnosis of HSIL and above lesions was 84.15% (69/82), and positive predictive value was 68.32% (69/101).Sensitivity of colposcopy in diagnosis of low grade squamous intraepithelial lesion (LSIL) and below was 94.24% (524/556), negative predictive value was 97.58% (524/537), false positive rate was 5.76%, and false negative rate was 15.85%.Colposcopy diagnosis and pathological diagnosis of 397 cases was accordant and the accordance rate was 62.23% (397/638).Conclusion Sensitivity and specificity of colposcopy in diagnosis of high degree cervical lesions is good.Colposcopy plays an important role in detecting cervical cancer in minority areas in Yunnan Province, and can be used as supplement for frontline screening program.