Department of Ultrasound, the Affiliated Yixing Hospital of Jiangsu University
Development Fund of Clinical science and Technology, Jiangsu University
目的：分析宫颈癌筛查异常患者的宫颈厚度特点，探讨宫颈厚度联合阴道镜检查对宫颈癌筛查异常患者的临床价值。方法：以病理诊断为金标准，回顾性分析322例宫颈癌筛查异常患者的阴道镜检查结果及经阴道超声正中矢状面宫颈厚度测量值，分析不同级别宫颈上皮内瘤变（cervical intraepithelial neoplasia, CIN）的宫颈厚度测值，绘制单一宫颈厚度、阴道镜检查及宫颈厚度联合阴道镜检查预测CINⅢ及以上病变（CINⅢ+，包括CINⅢ、癌变）的受试者操作特征（receiver operating characteristic, ROC）曲线。结果：146例宫颈炎症患者宫颈厚度为21.88±2.46mm，77例CINⅠ为23.76±3.05mm，53例CINⅡ为24.44±2.77mm，41例CINⅢ为26.28±3.22mm，5例宫颈癌（原位癌及Ia期）为26.80±2.49mm。宫颈厚度与CIN级别呈显著正相关（r=0.492，P＜0.001），不同CIN级别间宫颈厚度差异有统计学意义（P＜0.05），宫颈厚度联合阴道镜高级别鳞状上皮病变（high-grade squamous epithelial lesions, HSIL）预测CINⅢ+的曲线下面积最高，为0.915，宫颈厚度、阴道镜低级别鳞状上皮病变（low-grade squamous epithelial lesions, LSIL）、HSIL单独预测及宫颈厚度联合LSIL预测CINⅢ+的曲线下面积分别为0.793、0.703、0.824、0.854。结论：宫颈厚度对宫颈癌筛查异常患者评估CIN有一定的参考价值，其联合阴道镜检查对宫颈癌筛查异常患者CINⅢ+具有较高的预测价值。
Objective: To analyze the characteristics of cervical thickness detected by ultrasound in patients with abnormal cervical cancer screening tests, and to explore the clinical value of cervical thickness combined with colposcopy in patients with abnormal tests in cervical cancer screening. Methods: Taking pathological diagnosis as the gold standard, the colposcopy results and cervical thickness measured by transvaginal ultrasound in the median sagittal plane of 322 patients with abnormal cervical cancer screening tests were analyzed retrospectively. The cervical thickness measurements of different levels of cervical intraepithelial neoplasia (CIN) were compared, and the receiver operating characteristic(ROC) curves of single cervical thickness, colposcopy and cervical thickness combined colposcopy for predicting CINⅢ and above (CINⅢ+,including CINⅢ and canceration) were plotted. Results: The cervical thickness was 21.88±2.46mm in 146 patients with cervicitis, 23.76±3.05mm in 77 patients with CINⅠ, 24.44±2.77mm in 53 patients with CINⅡ, 26.28 ± 3.22mm in 41 patients with CINⅢ and 26.80±2.49mm in 5 patients with cervical cancer (carcinoma in situ and stage Ia). There was a significant positive correlation between cervical thickness and CIN level (r=0.492, P＜0.001) and there was significant difference in cervical thickness between different CIN levels (P＜0.05). Cervical thickness combined with colposcopic high-grade squamous epithelial lesions (HSIL) predicted the area under the curve (AUC) of CINⅢ+ was the highest, which was 0.915. The AUCs predicted by cervical thickness, colposcopic low-grade squamous epithelial lesions (LSIL), HSIL alone and cervical thickness combined with LSIL were 0.793, 0.703, 0.824 and 0.854 respectively. Conclusion: Cervical thickness has a certain reference value for patients with abnormal tests in cervical cancer screening, cervical thickness detection combined with colposcopy has a high predictive value for CINⅢ+ in patients with abnormal cervical cancer screening tests.