| Cervical cancer is the third common malignant tumor in the world. Although its incidence and mortality decreased year by year, but cervical cancer, about 85% occur in developing countries, ranking the first cancer death[1]. CIN is a group of cervical lesions which closely related with the invasive carcinoma of cervix, and high grade CIN has a malignant potential[2]. In recent years, The occurrence of CIN and cervical cancer in young women was increased along with the specification and popularization of the cervical cancer screening technology[3]. Colposcopy is one of the most important techniques for the early diagnosis of CIN and cervical cancer. By amplified subtle changes observation of epithelium and blood vessels of cervical and the lower genital tract,we can evaluate the extent and nature of the lesions, guide the biopsy and clinical treatment. Colposcopy is a kind of visual technology, thus the interpretation of the image is influenced by subjectivefactors, and the standard of diagnosis is not unified[4]. The establishment of colposcopy index system can objectively evaluate colposcopy image, reduce the influence of subjective factors, assist in evaluating the degree of lesion, and provide appropriate clinical data and suggest for pathological diagnosis. The current commonly used colposcopy scoring system on International are: Reid Colposcopy Index[5], Swede scoring system[6], Shafi-Nazeer scoring system[7],Coppleson grading system[8],etc. Reid colposcopy index is one of the most widely used in many scoring system. The R-way colposcopy diagnostic system, published in the second PKU International Forum of Obstetrics and Gynecology held in Beijing in 2014 for the first time, is a new diagnostic system, and has been clinical applicated in recent 3 years in china. This topic is aim to investigate the application value of colposcopy scoring system in diagnosis of cervical lesion by research of combining colposcopy with R-way colposcopy diagnostic system and Reid colposcopy index. Part I Clinical observation of combining colposcopy with Reid colposcopy index in diagnosis of cervical lesion Objective:To evaluate the efficacy and clinical significance of Reid colposcopy index in diagnosis of cervical lesion. Methods:Select 237 patients who had undergone medical tests such as colposcopy, cervical biopsy in Shanxi dayi hospital obstetrics and Gynecology colposcopy room during Jan.2014–Dec.2014. Then retrospective analysis and colposcopy diagnosis was made on colposcopic findings by full-time colposcopy doctor from the perspectives of Reid colposcopic index. RCI≥3 for high grade cases(including CIN II /CIN III /Ca) and RCI<3 for low grade cases(including normal colposcopy see /HPV /CIN I). Results:1. In the consistency comparation of Reid score and histopathology, by taking cervical tissue pathology as the gold standard, the high grade lesion group has 80% consistency with histopathology(115/144), pathological downstaging 20%(29/144); the low grade leison group has 72% consistency with histopathology(67/93), pathological upgrading 28%(26/93), the kappa value is 0.516, P<0.001. 2. The sensitivity of Reid colposcopy index is 81.56%, the specificity is 69.79%, the positive predictive value is 79.86%, the negative predictive value is 72.04%, the Youden index = 51.35%. Conclusions:Colposcopy diagnosis made by combining colposcopy with Reid colposcopy index has good consistency with cervical pathological, so it can improve the objectivity of colposcopy. Reid colposcopy index is practical, easy to learn, and useful for diagnosis and treatment of cervical lesions.Part II Clinical observation of combining colposcopy with R-way colposcopy diagnostic system in diagnosis of cervical lesion Objective:To evaluate the efficacy and clinical significance of R-way colposcopy diagnostic system in diagnosis of cervical lesion. Methods:Select 493 patients who had undergone medical tests such as colposcopy, cervical biopsy in Shanxi dayi hospital obstetrics and Gynecology colposcopy room during Jan.2014–Dec.2014. Then retrospective analysis and colposcopy diagnosis was made on colposcopic findings by full-time colposcopy doctor from the perspectives of R-way colposcopy diagnostic system. Divide the colposcopy diagnosis into high grade cases(including CIN II /CIN III /Ca) and low grade cases(including normal colposcopy see /HPV /CIN I). Results:In the consistency comparation of R-way colposcopy diagnostic system and histopathology, the high grade case group has 90.57% consistency with histopathology(218/244), pathological downstaging 9.43%(23/244); the low grade case group has 68.67% consistency with histopathology(171/249), pathological upgrading 31.33%(78/249), the kappa value is 0.58, P<0.001. The sensitivity of R-way colposcopy diagnostic system is 88.14%, the specificity is 73.91%, the positive predictive value is 68.67%, the negative predictive value is 90.57%, the Youden index = 62.05%. Conclusions:Colposcopy diagnosis made by combining colposcopy with R-way diagnostic system has good consistency with cervical pathological, so it can improve the colposcopy accuracy in diagnosis of cervical lesions, especially high grade lesions. Part III Comparative observation of R-way colposcopy diagnostic system and Reid colposcopy index in clinical application Objective:To compare the consistency, evaluate the effectiveness and clinical significance of R-way colposcopy diagnostic system and Reid colposcopy index. Methods:Select 237 patients who had undergone medical tests such as colposcopy, cervical biopsy in Shanxi dayi hospital obstetrics and Gynecology colposcopy room during Jan.2014–Dec.2014. Then retrospective analysis, colposcopy diagnosis and consistency comparation was made on colposcopic findings by adopting Blind method from the perspectives of R-way colposcopy diagnosis system and Reid colposcopy index. Results:In the comparison of R-way colposcopy diagnosis system and Reid colposcopy index, the kappa value is 0.623, P<0.001, the difference was not statistically significant(chi square test, P < 0.05). Conclusions:Reid colposcopy index is one of the most widely used in numerous colposcopy scoring method, and is helpful to improve the accuracy of colposcopy. R-way colposcopy diagnosis system has good consistency with Reid colposcopy index. The ability of R-way colposcopy diagnosis system is slightly better than the Reid colposcopy index in diagnosis of cervical lesions. |
