Objective To compare and evaluate the sensitivity, specificity, accuracy, negative and positive predictive values, negative and positive likelihood ratios of colposcopically directed biopsy and diagnostic cone biopsy in patients with cervical intraepithelial neoplasia. Methods We searched PubMed, CBMdisc, CMCC, CNKI, and VIP to March 2004, and Cochrane Library (Issue 4, 2003). Related journals published from 1970 to 2003 and unpublished papers were hansearched. Diagnostic studies which employed colposcopically directed biopsy or diagnostic cone biopsy and compared with golden standard (pathological diagnosis of specimens obtained through therapeutic conization or hysterectomy) were included and meta-analysis was performed. Participants were clinically suspected of pre-cancerous cervical lesions. Quality of studies was assessed, and SROC curve by Diagnostic and Screening Group of the Cochrane Collaboration was used to perform meta-analysis. Parameters were sensitivity, specificity, accuracy, predictive values, and likelihood ratio. Results Twenty six studies (3 376 patients ranging from 2 to 604 patients/per study) met the inclusion criteria. The quality of studies was generally poor.Before sensitivity analysis, superiority of diagnostic cone biopsy (sensitivity and specificity: 0.83) was shown over colposcopically directed biopsy (sensitivity and specificity: 0.76) (P＜0.001); while after sensitivity analysis the results reversed (sensitivity of diagnostic cone biopsy was 0.58 and its specificity was 0.61; sensitivity and specificity of colposcopically directed biopsy increased to 0.84) (Plt;0.001). Conclusions No definite conclusioncan be drawn as to which method is superior. To make further analysis, more studies with high quality are needed.
目的 探讨电子阴道镜在宫颈病变诊断中的价值。 方法 对2001年1月-2006年12月786例宫颈病变患者的阴道镜下行病检结果和巴氏刮片细胞学诊断结果进行对比性研究。 结果 慢性宫颈炎、宫颈上皮内瘤样病变和宫颈癌在阴道镜下图像均呈多样性；阴道镜诊断宫颈癌前病变及宫颈癌的正确率、灵敏度及特异度均高于宫颈巴氏刮片，差异有统计学意义(Plt;0.05)。 结论 阴道镜操作灵活简便，在宫颈病变的诊断中有较大价值，其图像管理系统更有利于宫颈病变的动态观察和随访。
摘要:目的: 调查新疆地区维吾尔族与汉族子宫颈癌及癌前病变发病情况,分析宫颈癌高发原因。 方法 : 2000年1月至2005年12月新疆自治区人民医院妇产科门诊及病房行宫颈细胞学检查的维吾尔族、汉族妇女进行筛查,对宫颈病变阳性者(CINI以上)行病理组织学检查,对结果进行对比分析、综合评价。 结果 : 宫颈涂片人数共计23 205例,其中维吾尔族6 999例、汉族16 206例。宫颈病变阳性者237例,经阴道镜下病理活组织检查证实CINI以上(包括CINI、CINII、CINIII、原位癌、鳞癌、腺癌)病变人数173例,最小年龄31岁,原位癌(维吾尔族)、最大年龄76岁,宫颈磷癌(汉族)。维吾尔族105例(6069%)、汉族68例(3931%)。每年阳性例数中维吾尔族均高于汉族,其中2000年、2001年、2004年、2005年有极显著性差异(P lt;001),2002年、2003年有显著性差异(P lt;005),维吾尔族、汉族在各年龄组中的发病情况无显著性差异(P gt;005)。 结论 : 新疆地区宫颈癌及癌前病变的高发原因是由地区环境、医疗条件、医学发展、救助措施等因素综合作用的结果。Abstract: Objective: To investigate the incidence of cervical cancer and cervical precancerous lesion of uigur nationality and han nationality, in addition, to analysis the cause of cervical cancer’s high incidence. Methods : At first screen cervical cytology of Uigur and Han outpatient and inpatient of department of gynecology and obstetrics in the People’s Hospital of Xinjiang Uigur Autonomous Region from January 1, 2000 to December 31, 2004Secondly biopsy for those patients that cervix pathological change shows positive, then contrast analysis and comprehensive evaluation. Results : Cervix smears are 23205 samples. Uigur nation has 6999 samples and Han nation has 16206 samples. There are 237 patients whose cervix pathological changes shows positive. Among them 173 samples were over CINⅠ(include CINⅠ,CINⅡ,CIN Ⅲ,carcinoma in situ, squamous carcinoma and adenocarcinoma) through colposcopy. The youngest was 31 and diagnosed carcinoma in situ(Uigur), the eldest was 76 and diagnosed squamous carcinoma(Han).The samples of Uigur is 105(6069%) and Han is 68(3931%).The positive samples in Uigur is higher than Han each year, the incidence has extremely significant difference among 2000,2001 and 2004(P lt;001), while it has significant difference between 2002 and 2003 (P lt;005), but in each age group it has no significant difference between Uigur and Han (P gt;005). Conclusion : The high incidence of cervical cancer and cervical precancerous lesion in xinjiang is contribute to environment, medical condition, medical development and aid measures coaffect.