朱成涛 1刘辉 1王南 1张楠 1王丽杰 1乔薇 1叶新华2
作者信息
- 1. 南京医科大学附属宿迁第一人民医院超声医学科,江苏宿迁 223800
- 2. 南京医科大学第一附属医院(江苏省人民医院)超声医学科,江苏南京 210029
- 折叠
摘要
Abstract
Objective:To investigate the clinical characteristics of transvaginal ultrasound-guided puncture biopsy in patients with cervical cancer missed diagnosis.Methods:Ninety-five patients with cervical cancer diagnosed by postoperative pathology in our hospital from April 2019 to October 2022 were divided into two groups:consistent group(n=75)and inconsistent group(n=20).The clinical data of the two groups were compared,the diagnostic efficacy was determined by receiver operator characteristic(ROC)curve,the risk factors of missed diagnosis were analyzed by Logistic regression,the line chart model was constructed by R 4.0.6 software,and the model was verified by Bootstrap self-sampling method.Results:The total coincidence rate of transvaginal ultrasound-guided biopsy in 95 patients with cervical cancer was 78.95％.The consistency test of the two diagnostic results showed that Kappa=0.762.The consistency of the results is good.The area under the curve of stage Ⅰ,stage Ⅱ,stage Ⅲand stage Ⅳ cervical cancer was 0.543(95％CI:0.07-1.00),0.877(95％CI:0.74-1.00),0.640(95％CI:0.15-1.00)and 0.734(95％CI:0.29-1.00).There were significant differences in age,times of pregnancy,previous cervical treatment history,clinical symptoms,grade of pathological examination,HPV infection,HPV classification and lesion/cervical area ratio between the two groups.Logistic multivariate regression analysis showed that previous cervical treatment history and clinical symptoms were independent risk factors,while more than 4 pregnancies,high-grade lesions,positive HPV infection and lesion/cervical area ratio≥50％were protective factors.The risk value of missed diagnosis of cervical cancer predicted by line chart model was 0.92.The ROC curve shows that the AUC of the model is 0.885(95％CI:0.786-0.915),the consistency index is 0.896(95％CI:0.782-0.997),and the discrimination is good.The calibration curve showed that the predicted probability fitted well with the reference probability,and there was no significant difference in the results of Hosmer-Lemeshow test.The decision curve shows that the probability range of optional threshold is wide and the net benefit is high,and the model has strong clinical practicability.The model has strong clinical practicability.Conclusion:The total coincidence rate of transvaginal ultrasound-guided puncture biopsy in patients with cervical cancer was 78.95％.The missed patients had the clinical characteristics of previous cervical treatment history,obvious clinical symptoms,less than 4 pregnancies,low-grade lesions,negative HPV infection and lesion/cervical area ratio＜50％.Based on this,the line chart model has good differentiation,high accuracy and strong clinical practicability.关键词
经阴道超声造影引导穿刺活检/宫颈癌/漏诊Key words
transvaginal contrast-enhanced ultrasound guided biopsy/cervical cancer/missed diagnosis
