摘要
目的:评估光学相干断层扫描(OCT)在子宫颈病变筛查和分诊中的应用价值。方法:纳入2022年9月至2024年6月在湖北省妇科门诊拟行阴道镜检查的1755例患者。所有患者均进行子宫颈OCT检查及活检病理检查。以病理诊断为金标准,分别以子宫颈上皮内瘤变2级及以上(CIN2^(+))或3级及以上(CIN3^(+))作为疾病终点结局,评估OCT对子宫颈病变的诊断性能,并探讨OCT作为高危型人乳头瘤病毒(HR-HPV)感染患者分诊工具的可行性。结果:共检出184例CIN2、141例CIN3^(+)。OCT诊断CIN2^(+)/CIN3^(+)的特异度为96.8%、90.8%,准确率为90.7%、89.5%,均显著高于薄层液基细胞学检查(TCT)和人乳头瘤病毒(HPV)检测,差异有统计学意义(P<0.001)。OCT诊断CIN2^(+)/CIN3^(+)的敏感度低于HPV检测(63.7%vs.95.1%、74.5%vs.95.7%,P<0.001)。OCT联合HPV检测诊断CIN2^(+)/CIN3^(+)的特异度、阳性预测值(PPV)、准确率均高于TCT联合HPV检测。HR-HPV感染者基于OCT分诊的阴道镜转诊率为15.7%,远低于TCT或HPV16/18基因分型分诊,且OCT分诊诊断CIN2^(+)/CIN3^(+)的特异度、PPV、阴性预测值(NPV)均高于TCT和HPV16/18基因分型分诊。对于HR-HPV感染者,TCT分诊阴性患者的CIN3^(+)风险为2.8%(<4%),而TCT和HPV16/18基因分型分诊阴性患者的CIN3^(+)风险均>4%。结论:OCT单独或联合HPV检测对子宫颈CIN2^(+)/CIN3^(+)的早期筛查具有良好的诊断性能,OCT分诊可减少HR-HPV感染者的阴道镜转诊率,并提高CIN2^(+)/CIN3^(+)的检出效率。
Objective:To evaluate the application value of optical coherence tomography(OCT)in the screening and triage of cervical lesion.Methods:A total of 1755 patients scheduled for colposcopy in the gynecology outpatient department of Hubei Province from September 2022 to June 2024 were enrolled.All patients underwent cervical OCT examination and pathological biopsy.With pathological diagnosis as the gold standard,cervical intraepithelial neoplasia(CIN)grade 2 or higher(CIN2+)or grade 3 or higher(CIN3+)were used as disease endpoint to assess the diagnostic performance of OCT for cervical lesions and to explore the feasibility of OCT as a triage tool for high-risk human papillomavirus(HR-HPV)infection.Results:A total of 184 cases of CIN2 and 141 cases of CIN3^(+)were detected.The specificity of OCT in diagnosing CIN2^(+)/CIN3^(+)were 96.8%and 90.8%,the accuracies were 90.7%and 89.5%,both significantly higher than those of thin-layer liquid-based cytology(TCT)and human papillomavirus(HPV)testing,with statistically significant differences(P<0.001).The sensitivity of OCT in diagnosing CIN2^(+)/CIN3^(+)was lower than that of HPV testing(63.7%vs.95.1%,74.5%vs.95.7%,P<0.001).The specificity,positive predictive value(PPV),and accuracy of OCT combined with HPV testing in diagnosing CIN2^(+)/CIN3^(+)were all higher than those of TCT combined with HPV testing.The colposcopy referral rate for HR-HPV infected patients based on OCT triage was 15.7%,which was significantly lower than that of TCT or HPV16/18 genotyping triage.Moreover,OCT triage demonstrated higher specificity,positive predictive value(PPV),and negative predictive value(NPV)in diagnosing CIN 2^(+)/CIN 3^(+)compared to TCT and HPV16/18 genotyping triage.For HR-HPV infected patients,the risk of CIN 3^(+)in TCT negative triage was 2.8%(<4%),whereas the risk in both TCT and HPV16/18 genotyping-negative triage was>4%.Conclusion:OCT alone or combined with HPV testing exhibits excellent diagnostic performance for early screening of cervical CIN2^(+)/CIN3^(+).OCT triage can reduce the colposcopy referral rate in HR-HPV infected patients and improve the detection efficiency of CIN 2^(+)/CIN3^(+).
作者
曹敏
陈欣
马雪勤
曾司源
李琳
陈克明
张毅
谷新
穆雪峰
张燕
CAO Min;CHEN Xin;MA Xueqin(Department of Obstetrics and Gynecology,Wuhan University People′s Hospital,Wuhan Hubei 430060,China)
出处
《实用妇产科杂志》
北大核心
2026年第2期145-151,共7页
Journal of Practical Obstetrics and Gynecology
基金
湖北省重点研发计划项目(编号:2022BCA010)
湖北省卫生健康科技项目(编号:WJ2025M075)。
关键词
子宫颈癌筛查
分诊
光学相干断层扫描
人乳头瘤病毒
薄层液基细胞学检查
Cervical cancer screening
Triage
Optical coherence tomography
Human papillomavirus
Thin-layer liquid-based cytology
