宫颈细胞学准确性研究:挪威3家医院4名病理医生100例巴氏涂片判读结果比较

2022-05-02 11:37:59

【编者按】宫颈癌可通过早期诊断及治疗宫颈癌前病变来预防，而癌前病变筛查的准确性与多种因素有关。本文将介绍一项关于挪威病理医生对宫颈细胞学准确性的研究。

背景介绍

子宫颈癌可以通过对宫颈癌前病变的早期诊断及治疗预防。挪威自1995年起开展一项全国性子宫颈癌筛查项目，建议年龄在25-69岁之间的女性每3年接受一次巴氏涂片检查。共17个细胞学实验室承担了挪威500万人口的筛查任务。但宫颈疾病的检出率因实验室而异。为此，我们对来自挪威3家医院的4名不同病理医生的细胞学诊断结果准确性进行调查。

Background:Cervical cancer can be prevented by early detection and treatment for precancerous lesions. Since1995, there has been a national cervical cancer screening program in Norway, where women aged 25–69 years are recommended to take Pap smears every three years. There are 17 cytology laboratories covering a population of 5 million people. The detection rate of cervical abnormalities varies from laboratory to laboratory. We wanted to investigate the accuracy of cytology diagnoses by four different pathologists at three different hospitals in Norway.

研究方法

2015年UNN（北挪威大学医院）筛查出的100例巴氏涂片结果（20例正常，20例 ASC-US，20例 LSIL，20例 ASC-H和20例 HSIL）被送至挪威的3家医院，接受4名病理医生的再次评估。

所有患者均随访至2016年12月，经组织学确诊的高度非典型性增生（CIN2 +）被认为是金标准。本次研究以细胞学检查结果提示高级别鳞状上皮内病变（ASC-H +）为临界点，即当细胞学结果提示ASC-H +病变时，认为其成功诊断出了CIN2 +病变。

Methods: One hundred Pap smears (20 Normal, 20 ASC-US, 20 LSIL, 20 ASC-H and 20 HSIL) screened at UNN in 2015 were evaluated by four pathologists at three hospitals in Norway. All patients were followed up through December 2016. Histologically confirmed high-grade dysplasia (CIN2+) was considered as study endpoint.

研究结果

100例巴氏涂片中被4名病理医生巴氏涂片诊断为异常（ASC-US +）的数量自61至85不等，诊断为高度病变（ASC-H +）的数量自26至50不等。4名病理医生诊断结果的一致性中等（加权Kappa系数0.45 -0.58）。在随访的过程中，有32名患者经组织学确诊高度非典型性增生（CIN2 +），其中包括19例CIN2、12例CIN3和1例鳞状细胞癌（SCC）。

4名病理医生通过细胞学检查，诊断出CIN2 +病变的敏感度为68.8%至93.8％不等（平均77.4％），特异度为70.6%至95.6％不等（平均81.3％）。

对CIN2 +病变诊断敏感度最高的病理医生的假阳性率最高且特异度最低（p <0.05）。

4名病理医生通过细胞学检查诊断出CIN2 +病变的准确度为74.1%至83.8％不等（平均为79.4％）。

4名病理医生中仅有1人将宫颈癌巴氏涂片判读为高度病变（ASC-H +）。

Results: The number of Pap smears evaluated as abnormal (ASC-US+) by the four pathologists varied from 61 to 85. The number of high-grade cytology (ASC-H+) varied from 26 to 50. There was moderate agreement (weighted kappa 0.45–0. 58) between the observers. There were 32 women with high-grade histology (CIN2+) in the follow-up, including 19 CIN2, 12 CIN3 and one squamous cell carcinoma (SCC). Using high-grade cytology (ASC-H+) as cut-off, the sensitivity for CIN2+ varied from 68.8% to 93.8% (mean 77.4%) and specificity from 70.6% to 95.6% (mean 81.3%). The pathologist with the highest sensitivity for CIN2+ had the highest false positive rate and the lowest specificity (p<0.05). The accuracy for CIN2+ varied from 74.1% to 83.8% (mean 79.4%). The Pap smear from the woman with cervical cancer was diagnosed as high-grade (ASC-H+) by one of the four pathologists.

研究结论

基于细胞学检查的宫颈癌筛查准确性有限。本次研究显示不同阅片者给出的诊断结果的一致性中等，且检出CIN2 +病变的敏感度与特异度呈负相关。这可能提示宫颈细胞学检测率较高的医院对CIN2 +病变检出的敏感度较高，但特异度较低。

Conclusions: Cervical cancer screening based on cytology has limited accuracy. The study revealed a moderate agreement between the observers, along with a trade-off between sensitivity and specificity. This might indicate that hospitals with high detection rates of cervical cytology have higher sensitivity for CIN2+ but lower specificity

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结语

该项研究提醒我们，宫颈细胞学结果判定在敏感性和特异性方面有一定的局限性。宫颈细胞学检查要注意与HPV联合检测，并且通过定期检测减少漏诊的发生。

本文相关专业名词可查阅公众号历次名词解析：

名词解析（五）巴氏涂片（Pap smear）

名词解析（十一）宫颈癌前病变

名词解析（十八）ASCUS（意义不明的非典型鳞状细胞）

名词解析（二十）ASC-H（不能排除高级别鳞状上皮内病变的非典型鳞状上皮细胞）

原创声明

本文系“守护女性宫颈健康”原创

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撰稿 | 李旭

编辑 | 刘应南

校对 | 王靖元

审核 | 陶霞

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