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질확대경진 점수에 의한 자궁경 병변의 분류

The Use of Colposcpic Scoring System in the Classification for Cervial Neoplasms

대한산부인과학회지 1994년 37권 12호 p.2406 ~ 2413
한구택
신재인/유기성/강창석/심상인/남궁성은/이헌영/김수평

Abstract


Colposcopic signs demarcation, surface contour, color change and abnormal vessels of the cervical lesions of two hundreds and seventy four patients, who were entered into this study, were graded into three objective categories representing
subclinical
papillomaviral infection, CIN I-II and CIN III and/or above by scoring. These were evaluated by histopathologic findings of benign warty change, presumed viral atypia, abnormal cell phenotype and distubed tissue maturation to evaluate the
accuracy
of
this colposcopic differentiation between the different histologic grades of lesins by scording.
In this study, we used the modified colposcopic indices excluding the Lugol's iodine statining. The lesions with minor colposcopic signs, which were scored below 2, were attrbutable to human papillomaviral disturbances of cel growth and
maturation,
which were seen histologically as parabasal layer proliferation, papillomatosis, koilocytosis, and dyskeratosis. Major colposcopic abnormalities, which were scored 6 and/or avove, reflect extensive disorganization of cell phenotype and tissue
architecture. Intermediate colposcopic patterns, which had scores between 3 and 5, generally denote the reciprocal tissue changes of a composite of the benign warty expression and the premalignant change.
We also observed that a highly significant statistical relationship exists between subclinical papilloomaviral infection and the occurrence of cervical neoplasia correlated by colposcopic signs and histologic indices(X*=268.29, p=0.0001).
In the colposcopic diagnosis for subclinical papillomaviral infection, we observed that the sensitivity and specificity were 90.5% and 94.95% and the positive and negative predictive value were 94.7% and 90.9% respectively. The sensitivity and
specificity for CIN III and/or above were 78.2% and 94.4% and the positive and negative predictive value were 78.2% and 94.4% and the positive and negative predictive value were 97.5% and 60.7%, respectively.
These results suggest that the colposcopic scoring is very useful for the diagnosis and differentiation of the various cervical lesions.

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