背景:阴道镜在宫颈癌前病变的治疗方案中起着关键作用。研究的目的/是在使用各种避孕药的育龄妇女中使用瑞典人评分系统进行阴道镜观察宫颈变化:常规方法(屏障方法,性交中断),口服避孕药(OCPs),铜T和双侧管切除术。该研究的目的是使用瑞典人评分系统观察和评估阴道镜检查结果,以诊断使用各种避孕药的育龄妇女的癌前/恶性病变。
方法:这是一项前瞻性观察研究,在印度北部的一家三级保健机构中,对200名育龄妇女使用各种避孕药具进行了研究。PAP涂片,直接目视检查,VIA(乙酸目视检查)检查,阴道镜检查,和(活检,如果指征)。收集了数据,并使用MicrosoftExcelOffice软件2019版本19.11和epiinfo(CDC亚特兰大)7.23.1进行分析。使用百分比进行统计分析,意思是,mode,中位数,标准偏差,卡方,费希尔检验,Anova测试。
结果:我们发现61.50%的PAP(巴氏试验)涂片阳性,9%的VIA检查呈阳性,阴道镜检查结果为阳性的占28.50%,瑞典人在100%得分为0-3(0-91%,1-2%,2-6%,和3-1%)和9%受试者的活检阳性。在1.00%的PAP涂片中观察到恶性发现。阴道镜检查结果为8.5%的CIN1(宫颈上皮内瘤变1)和0.5%的CIN2。瑞典人在91%的得分为零,2%中的1个,2在6%,1%的受试者中有3人。HPE(组织病理学检查)为慢性宫颈炎,占8.50%,轻度异型增生/CIN1占0.5%。除Cu-T使用者p=0.0184外,任何组的避孕药具选择与假阳性测试结果或疾病患病率之间均无统计学意义(尤其是CIN2;所有组的p=0.0109和CIN1均高于Cu-T使用者)。阴道镜敏感性100%,特异性91.46%(0/0=0%)PPV=5.56%,净现值=100%,检测轻度发育不良/CIN的准确性=91.5%-无显著性(p=0.055)。我们的研究主要是低度病变,NPV为100%。随着瑞典人分数的增加,敏感性增加,但以特异性为代价,但无统计学意义(p=0.055).
结论:我们的研究可以指导阴道镜检查与瑞典评分的合理使用,这很容易,学习曲线低,作为诊断工具,但仅在由于假阳性结果高率而指示宫颈不健康的情况下。在低度病变中,排除这种疾病非常有用。
BACKGROUND: Colposcopy has a key role to play in see-and-treat programs for premalignant cervical lesions. The aim of the
study/was to observe cervical changes with a colposcope using the Swede scoring system in fertile age group women using various contraceptives: conventional methods (barrier methods, coitus interruptus), oral contraceptives (OCPs), copper-T and bilateral tubectomy. The aim of the
study was to observe and evaluate the colposcopic findings using the Swede scoring system for the diagnosis of premalignant/malignant lesions in reproductive age group women using various contraceptives.
METHODS: This was a prospective observational
study, conducted among 200 women of reproductive age group using various contraceptives in a tertiary care institute in North India. PAP smear, direct visual examination, VIA (Visual Inspection with Acetic Acid) examination, colposcopic examination, and (biopsy if indicated) were done. The data were collected, and analysis was done using Microsoft Excel Office Software 2019 version 19.11 and epi info (CDC Atlanta) 7.23.1. Statistical analysis was done using percentages, mean, mode, median, standard deviation, Chi-square, Fisher\'s Test, and Anova Test.
RESULTS: We found positive PAP (Papanicolaou test) smears in 61.50%, positive VIA examination in 9%, and positive findings in colposcopic examination in 28.50%, Swede score of 0-3 in 100% (0-91%, 1-2%, 2-6%, and 3-1%) and positive biopsy in 9% subjects. Malignant findings were observed in 1.00% of PAP smears. Colposcopic findings were CIN 1 (cervical intraepithelial neoplasia 1) in 8.5% and CIN 2 in 0.5% subjects. Swede score was zero in 91%, 1 in 2%, 2 in 6%, and 3 in 1% of subjects. HPE (histopathological examination) was chronic cervicitis in 8.50% and mild dysplasia/CIN 1 in 0.5%. No significant statistical associations between contraceptive choice and false-positive test results or disease prevalence was found in any group except Cu-T users p = 0.0184 (especially for CIN 2; p = 0.0109 and CIN 1 more in all groups than Cu-T users). Colposcopy had sensitivity 100%, specificity 91.46% (0/0 = 0%) PPV = 5.56%, NPV = 100%, Accuracy = 91.5% for detecting mild dysplasia/CIN-non-significant (p = 0.055). Our
study had mainly low-grade lesions with 100% NPV. With increase in Swede Score, sensitivity increases but at the expense of specificity but it was statistically non-significant (p = 0.055).
CONCLUSIONS: Our
study may guide the rational use of colposcopy with Swede scoring for see-and-treat lesions, which is easy and with a low learning curve, as a tool for diagnosis but only in cases where indicated like unhealthy cervix because of the high rate of false-positive results. In low-grade lesions, it is highly useful to rule out the disease.