摘要
Abstract
Objective To investigate the influencing factors of missed detection of cervical intraepithelial neoplasia(CIN)grade Ⅱ and above through colposcopy combined with cervical liquid-based cytology(LBC,commonly known as TCT in China)screening.Methods A total of 78 patients who presented with symptoms and signs such as abnormal vaginal discharge,contact bleeding,cervical erosion or polyps,or were diagnosed with suspected cervical lesions through health check-ups and underwent colposcopy-guided biopsy from January 2021 to January 2024 were selected as the study subjects.The patients'ages ranged from 27 to 66(39.54±9.28)years.After admission,all patients underwent colposcopy and TCT.The postoperative pathological examination results of cervical loop electrosurgical excision procedure(LEEP)were used as the gold standard to evaluate the sensitivity,specificity,positive predictive value,and missed diagnosis rate of colposcopy and TCT alone and in combination in screening CIN grade Ⅱ or higher.Univariate and multivariate logistic regression analyses were used to determine the risk factors affecting the missed diagnosis of CIN grade Ⅱ or higher.Results The sensitivity of TCT in diagnosing CIN grade Ⅱ or higher was 38.30％(18/47),the specificity was 77.42％(24/31),the positive predictive value was 72.00％(18/25),and the missed diagnosis rate was 61.70％(29/47);the sensitivity of colposcopy in diagnosing CIN grade Ⅱ or higher lesions was 42.55％(20/47),the specificity was 74.19％(23/31),the positive predictive value was 71.43％(20/28),and the missed diagnosis rate was 57.45％(27/47).The sensitivity of colposcopy combined with TCT in diagnosing CIN grade Ⅱ or higher was 70.21％(33/47),the specificity was 80.64％(25/31),the positive predictive value was 84.62％(33/39),and the missed diagnosis rate was 29.79％(14/47).Patient age≥40 years,unclear colposcopy images,cervical lesion area<1/2,and a single biopsy specimen were independent risk factors for missed diagnosis of CIN grade Ⅱ or higher(P<0.05).Conclusion Colposcopy combined with TCT can enhance the sensitivity,specificity,positive predictive value in screening for CIN grade Ⅱ or higher,reduce the rate of missed diagnoses,but there are still some cases of missed diagnoses.The patient's age≥40 years,unclear colposcopy images,cervical lesion area<1/2,and a single biopsy specimen are independent risk factors for missed diagnoses of CIN grade Ⅱ or higher.关键词
宫颈上皮内瘤变/阴道镜/宫颈液基细胞学检查/宫颈环形电切术/漏检/危险因素/病理检查Key words
cervical intraepithelial neoplasia/colposcope/cervical thin-prep cytologic test/loop electrosurgical excision procedure/missed detection/risk factor/pathological examination
