R-way阴道镜诊断系统在宫颈疾病诊断中的应用价值

王立群; 何玉; 李旭; 杨康; 朱宏; 王亚飞

doi:10.16766/j.cnki.issn.1674-4152.002684

R-way阴道镜诊断系统在宫颈疾病诊断中的应用价值

doi: 10.16766/j.cnki.issn.1674-4152.002684

蚌埠医学院第一附属医院妇科，安徽蚌埠 233004

基金项目:

安徽省教育厅重点项目 KJ2019A0343

蚌埠医学院2019年自然科学重点项目 BYKY2019 119ZD

详细信息

通讯作者:
何玉, E-mail: 1204675442@qq.com

中图分类号: R711.74
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- 被引次数: 0
出版历程
- 收稿日期: 2021-09-30
- 网络出版日期: 2022-11-30

Clinical application value of R-way colposcopy diagnosis system in diagnosing cervical diseases

Department of Gynecology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的评估R-way阴道镜诊断系统在宫颈疾病诊断中的临床应用价值。方法 2018年1—12月在蚌埠医学院第一附属医院阴道镜门诊就诊的患者中，选取保留有完整图像及病理随访结果的380例患者，应用R-way阴道镜诊断系统对图像进行回顾性分析并给出诊断结果，以宫颈组织病理诊断为“金标准”，比较R-way诊断系统与2011版阴道镜诊断术语对宫颈病变诊断的敏感度、特异度、约登指数及一致性，并计算ROC曲线下面积，评估R-way诊断系统在宫颈疾病诊断方面的临床应用价值。结果 R-way系统诊断宫颈癌的灵敏度为62.9%，特异度为100.0%，约登指数为69.2%，符合率为98.9%；诊断宫颈高级别上皮内病变的灵敏度为84.9%，特异度为89.5%，约登指数为74.5%，符合率为88.4%；诊断宫颈低级别上皮内病变的灵敏度为76.1%，特异度为79.0%，约登指数为55.1%，符合率为78.2%。设定宫颈高级别以上病变为阳性组，低级别以下病变为阴性组；R-way诊断系统诊断宫颈阳性病变的灵敏度为86.8%，特异度为90.5%；2011版阴道镜诊断术语诊断宫颈阳性病变的灵敏度为73.6%，特异度为90.9%；两者诊断宫颈阳性病变的ROC曲线下面积分别为0.887、0.822。结论 R-way诊断系统是一种简单易学、稳定有效的客观评价阴道镜图像的诊断系统，具有较高的临床应用和推广价值。
- R-way诊断系统 /
- 宫颈疾病 /
- 阴道镜检查 /
- 诊断技术
Abstract: Objective To evaluate the clinical value of the R-way colposcopy diagnosis system in diagnosing cervical diseases. Methods From January 2018 to December 2018, amongst the patients who visited the colposcopy clinic of the First Affiliated Hospital of Bengbu Medical College, 380 patients with complete image and pathological follow-up results were selected. The R-way diagnosis system was used to analyse the images retrospectively and provide diagnosis results. Histopathological diagnosis was taken as the "gold standard" to compare the sensitivity, specificity, Youden index, and consistency test of the R-way diagnostic system and 2011 colposcopy diagnostic terms in the diagnosis of cervical lesions. We further calculated the area under the ROC curve and evaluated the clinical value of the R-way diagnostic system in diagnosing cervical diseases. Results The R-way diagnosis system had a sensitivity of 62.9%, a specificity of 100.0%, Youden index of 69.2%, and a concordance rate of 98.9% for diagnosing cervical cancer. The sensitivity for diagnosing high-grade squamous intraepithelial lesions (HSIL) was 84.9%, the specificity was 89.5%, the Youden index was 74.5%, and the concordance rate was 88.4%. The sensitivity for diagnosing low-grade squamous intraepithelial lesions (LSIL) was 76.1%, specificity was 79.0%, Youden index was 55.1%, and concordance was 78.2%. With the assumption that HSIL and above lesions were the positive group, LSIL and other lesions were the negative group. The sensitivity of the positive group of the R-way system and colposcopic terminology were 86.8% and 73.6%, respectively, the specificity were 90.5% and 90.9%, and the area under the ROC curve were 0.887 and 0.822. Conclusion The R-way diagnostic system is a simple, easy, stable and effective diagnostic system for objectively evaluating colposcopic images. It has high-potential clinical application and promotion value.
- R-way diagnosis system /
- Cervical diseases /
- Colposcopy /
- Diagnostic techniques

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图 1 R-way阴道镜图像

注：A为红区，B为白区，C为黄区，D为A结构。

Figure 1. R-way colposcope image

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图 2 R-way诊断系统与2011阴道镜诊断术语诊断宫颈阳性病变的ROC曲线

Figure 2. ROC curve of R-way diagnostic system and 2011 colposcopy diagnostic terminology for diagnosing cervical positive lesions

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表 1 R-way诊断系统与阴道镜诊断术语评价指标(%)

Table 1. Comparison of R-way diagnostic system and colposcopy diagnostic value

项目	检查方法	灵敏度(95% CI)	特异度(95% CI)	阳性预测值(95% CI)	阴性预测值(95% CI)	约登指数	符合率
癌	R-way	69.2(44.1~94.3)	100.0(100.0~100.0)	100.0(100.0~100.0)	98.9(97.9~100.0)	69.2	98.9
	阴道镜	61.5(35.1~88.0)	99.7(99.2~100.3)	88.9(68.4~109.4)	98.7(97.5~99.8)	61.3	98.4
HSIL	R-way	84.9(77.7~92.2)	89.5(86.0~93.1)	72.5(64.1~80.9)	94.8(92.2~97.5)	74.5	88.4
	阴道镜	68.8(59.4~78.2)	89.5(86.0~93.1)	68.1(58.7~77.5)	89.9(86.4~93.4)	58.4	84.5
LSIL	R-way	76.1(68.2~84.0)	79.0(74.1~83.9)	60.6(52.5~68.6)	88.7(84.6~92.7)	55.1	78.2
	阴道镜	72.6(64.3~80.8)	76.0(70.9~81.2)	56.2(48.1~64.2)	86.8(82.4~91.1)	48.6	75.0

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表 2 R-way诊断系统及阴道镜诊断价值比较

Table 2. Comparison of R-way diagnostic system and colposcopy diagnostic value

检查方法	真阳性 (例)	假阳性 (例)	真阴性 (例)	假阴性 (例)	灵敏度 (95% CI, %)	特异度 (95% CI, %)	阳性预测值 (95% CI, %)	阴性预测值 (95% CI, %)	约登指数 (%)	符合率 (%)	ROC曲线下面积 (95% CI)
R-way诊断系统	92	26	248	14	86.8(80.3~93.2)	90.5(87.0~94.0)	78.0(70.5~85.4)	94.7(91.9~97.4)	77.3	89.5	0.887±0.022(0.844~0.929)
阴道镜诊断术语	78	25	249	28	73.6(65.2~82.0)	90.9(87.5~94.3)	75.7(67.4~84.0)	89.9(86.3~93.4)	64.5	86.1	0.822±0.027(0.769~0.876)

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