摘要
目的探讨电子阴道镜(EC)检查对宫颈人乳头瘤病毒亚临床感染(SPI)和宫颈上皮内瘤样变(CIN)的诊断价值及其与病理诊断的一致性。方法1420例在EC下筛查,对209例拟诊病例观察其EC图像,行宫颈活检病理学和HPV-6、11、18型免疫组化检查。结果SPI和CIN的EC图像主要是不同程度的醋酸白色上皮、血管异常改变和碘阴性染色。HPV感染的病理组织学特征是挖空细胞形成,这种病变在大部分的SPI和CIN患者中被发现(62例,74.6%)。病理形态学结合免疫组化诊断SPI56例(26.79%),CINⅠ10例(4.78%),CINⅡ9例(4.31%),CINⅢ8例(3.83%),宫颈炎126例(60.29%)。HPV-6、11、18型免疫组化的总检出率为23%(48/209)。EC诊断SPI、CIN和慢性宫颈炎与病理诊断的一致率(准确度)为88.04%(184/209,Kappa=0.755,P<0.01),灵敏度90.36%(75/83),特异度86.51%(109/126),阳性预测值81.52%(75/92),阴性预测值93.16%(109/117),两种检查结果比较差异无显著性(P>0.05)。结论EC是一种有效可靠的诊断宫颈病变的筛查方法,在EC下取活检结合免疫组织化学能提高SPI和CIN的早期诊断率。
Objective ：To investigate the diagnostic value of electro-colposcope （EC） examination in patients with subclinical human papillomavirus （HPV） infection（SPI） and cervical intraepithelial neoplasia （CIN）, and its concordance with pathologic diagnosis. Methods：Totally 1 420 females were examinaed with EC, and cervix biopsies and immunotistochemistry stalnings for HPV-6, 11,18 were performed in 209 of them. Results： EC images of SPI and CIN showed that there were a various of degrees of blanc epithelium stained acetic acid, abnormal blood vessel and iodine negative staining. Histologically, HPV infection was characterized by koilocytosis, and the lesion was found in most （62, 74. 6% ） patients with SPI and CIN. By light microscopic observation and immunotistochemistry technique, SPI was founded in 56 cases （20.79% ）, CIN Ⅰ in 10 cases （4. 78% ）, CIN Ⅱ in 9 cases （4. 31% ）, CIN Ⅲ in 8 cases（3. 83% ） and chronic cervicitis in 126 cases （60. 29% ） . The positivie stain rate of HPV-6, 11, 18 was 23% （48/209）. The coincidence ratio of EC examination and pathological diagnosis was 88. 04% （ 184/209, kappa value = 0.755, P 〈 0. 01 ）. The sensitivity, specificity, positive predictive value and negative predictive value of EC examination for SPI and CIN were 90. 36% （75/ 83）, 86. 51% （109/126）, 81.52% （75/92） and 93. 16% （109/117）, respectively. There was no significant difference between the two examination methods （ P 〉 0. 05 ）. Conclusion： It is suggested that EC is an effective and reliable diagnostic method for cervix lesions. Early diagnosis rates of SPI and CIN would be elevated by colposcopic biopsies of the cervix and combining with immunotistochemistry technique.
出处
《临床肿瘤学杂志》
CAS
2006年第5期343-347,共5页
Chinese Clinical Oncology
关键词
人乳头瘤病毒亚临床感染
宫颈上皮内瘤变
阴道镜
免疫组织化学
Subclinical human papillomavirus infection
Cervical intraepithelial neoplasias
Colposcope
Immunotistochemistry
