背景:原发性宫颈癌筛查和癌前病变治疗是预防宫颈癌的有效方法。然而,在大多数发展中国家,甚至一些发达国家,人乳头瘤病毒(HPV)疫苗和常规筛查的覆盖率都很低。本研究旨在探索人工智能辅助细胞学(AI)系统在中国宫颈癌高危人群筛查计划中的益处。
方法:收集2018年至2020年在解放军总医院接受阴道镜检查的女性液基细胞学(LBC)切片1231张。所有妇女都根据阴道镜检查和活检的结果接受了组织学诊断。灵敏度(Se),特异性(Sp),阳性预测值(PPV),负预测值(NPV),假阳性率(FPR),假阴性率(FNR),总体精度(OA),正似然比(PLR),人工智能的负似然比(NLR)和尤登指数(YI),LBC,HPV,LBC+HPV,AI+LBC,计算低度鳞状上皮内病变(LSIL)和高度鳞状上皮内病变(HSIL)阈值的AI+HPV和HPVSeqLBC筛查策略以评估其有效性。进行受试者工作特征(ROC)曲线分析以评估不同筛查策略的诊断价值。
结果:在LSIL和HSIL阈值下,初级AI单独策略的Se和Sp优于LBC+HPV共检测策略。在筛查策略中,AI策略在LSIL+阈值和HSIL+阈值的YI值最高。在HSIL+阈值处,人工智能战略取得了最好的结果,AUC值为0.621(95%CI,0.587-0.654),而HPV检测结果最差,AUC值为0.521(95%CI,0.484-0.559)。同样,在LSIL+阈值,基于LBC的策略取得了最好的结果,AUC为0.637(95%CI,0.606-0.668),而HPV检测结果最差,AUC为0.524(95%CI,0.491-0.557)。此外,在该阈值下,AI和LBC策略的AUC相似(分别为0.631和0.637).
结论:这些结果证实,仅AI筛查是诊断HSIL和LSIL的最权威方法,提高阴道镜诊断的准确性,并且比传统的LBC+HPV共检测对患者更有益。
BACKGROUND: Primary cervical cancer screening and treating precancerous lesions are effective ways to prevent cervical cancer. However, the coverage rates of human papillomavirus (HPV) vaccines and routine screening are low in most developing countries and even some developed countries. This study aimed to explore the benefit of an artificial intelligence-assisted cytology (AI) system in a screening program for a cervical cancer high-risk population in China.
METHODS: A total of 1231 liquid-based cytology (LBC) slides from women who underwent colposcopy at the Chinese PLA General Hospital from 2018 to 2020 were collected. All women had received a histological diagnosis based on the results of colposcopy and biopsy. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), false-positive rate (FPR), false-negative rate (FNR), overall accuracy (OA), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and Youden index (YI) of the AI, LBC, HPV, LBC + HPV, AI + LBC, AI + HPV and HPV Seq LBC screening strategies at low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) thresholds were calculated to assess their effectiveness. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic values of the different screening strategies.
RESULTS: The Se and Sp of the primary AI-alone strategy at the LSIL and HSIL thresholds were superior to those of the LBC + HPV cotesting strategy. Among the screening strategies, the YIs of the AI strategy at the LSIL + threshold and HSIL + threshold were the highest. At the HSIL + threshold, the AI strategy achieved the best result, with an AUC value of 0.621 (95% CI, 0.587-0.654), whereas HPV testing achieved the worst result, with an AUC value of 0.521 (95% CI, 0.484-0.559). Similarly, at the LSIL + threshold, the LBC-based strategy achieved the best result, with an AUC of 0.637 (95% CI, 0.606-0.668), whereas HPV testing achieved the worst result, with an AUC of 0.524 (95% CI, 0.491-0.557). Moreover, the AUCs of the AI and LBC strategies at this threshold were similar (0.631 and 0.637, respectively).
CONCLUSIONS: These results confirmed that AI-only screening was the most authoritative method for diagnosing HSILs and LSILs, improving the accuracy of colposcopy diagnosis, and was more beneficial for patients than traditional LBC + HPV cotesting.