The Distribution of Cervical Transformation Zone and Its Impact on Colposcopic Diagnosis: A Multicenter Study in China.

IF 2.4 4区医学 Q2 OBSTETRICS & GYNECOLOGY Journal of Lower Genital Tract Disease Pub Date : 2024-10-10 DOI:10.1097/LGT.0000000000000838

Zichen Ye, Xiaoli Cui, Huike Wang, Mingyang Chen, Qu Lu, Yu Jiang, Peng Xue, Youlin Qiao

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Abstract

Objective: The value of the transformation zone (TZ) is often overlooked in clinical settings. This study aims to assess TZ distribution, associated factors, and its impact on colposcopic diagnosis.

Methods: χ2 tests were used to analyze demographics, clinical history, and tissue samples to examine the differences in TZ distribution. Factors affecting the TZ were explored using logistic regression, and diagnostic indicators were calculated.

Results: A total of 5,302 individual datasets were finally included. TZ1, TZ2, and TZ3 accounted for 31.6%, 38.5%, and 30.0%, respectively. Age is the most important factor that influences the location of the TZ. The proportion of TZ3 steadily increased with age, comprising over 55% in women over 50. The colposcopic diagnostic performance shows that high-grade squamous intraepithelial lesion or worse (HSIL+) sensitivity of TZ3 (58.1%, 95% confidence interval [CI] = 52.9-63.4) is significantly lower than that of TZ1 (69.8%, 95% CI = 65.5-74.1) and TZ2 (73.2%, 95% CI = 69.7-76.8). The HSIL+ specificity of TZ3 (96.3, 95% CI = 95.3-97.4) was higher than that of TZ1 (96.3, 95% CI = 95.2-97.3) and TZ2 (92.5, 95% CI = 91.1-93.9). The HSIL+ positive predictive value (81.3%, 95% CI = 76.4-86.2) and negative predictive value (89.3%, 95% CI = 87.6-90.9) for TZ3 are high, with no significant differences when compared with TZ1 and TZ2.

Conclusions: Age predominantly influences TZ location, with TZ3 being most frequently found in women over 50. While TZ3 poses a higher risk of missed diagnosis during colposcopy, it remains clinically valuable in identifying diseased and nondiseased status. Increasing colposcopists' awareness of TZ importance is needed in clinical practice.

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宫颈转化区的分布及其对阴道镜诊断的影响：中国的一项多中心研究

目的：转化区（TZ）的价值在临床中常被忽视。本研究旨在评估 TZ 的分布、相关因素及其对阴道镜诊断的影响。方法：采用 χ2 检验分析人口统计学、临床病史和组织样本，研究 TZ 分布的差异。采用逻辑回归法探讨影响 TZ 的因素，并计算诊断指标：最终共纳入 5302 个数据集。TZ1、TZ2 和 TZ3 分别占 31.6%、38.5% 和 30.0%。年龄是影响 TZ 位置的最重要因素。随着年龄的增长，TZ3 的比例稳步上升，在 50 岁以上的女性中占 55% 以上。阴道镜诊断结果显示，TZ3（58.1%，95% 置信区间 [CI] = 52.9-63.4）的高级别鳞状上皮内病变或更差（HSIL+）敏感性明显低于 TZ1（69.8%，95% CI = 65.5-74.1）和 TZ2（73.2%，95% CI = 69.7-76.8）。TZ3的HSIL+特异性（96.3，95% CI = 95.3-97.4）高于TZ1（96.3，95% CI = 95.2-97.3）和TZ2（92.5，95% CI = 91.1-93.9）。TZ3的HSIL+阳性预测值（81.3%，95% CI = 76.4-86.2）和阴性预测值（89.3%，95% CI = 87.6-90.9）较高，与TZ1和TZ2相比无显著差异：年龄是影响TZ位置的主要因素，TZ3最常见于50岁以上的女性。虽然 TZ3 在阴道镜检查中的漏诊风险较高，但它在鉴别有病和无病状态方面仍有临床价值。在临床实践中，需要提高阴道镜医师对TZ重要性的认识。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Lower Genital Tract Disease OBSTETRICS & GYNECOLOGY-

CiteScore

6.80

自引率

8.10%

发文量

158

审稿时长

6-12 weeks

期刊介绍： The Journal of Lower Genital Tract Disease is the source for the latest science about benign and malignant conditions of the cervix, vagina, vulva, and anus. The Journal publishes peer-reviewed original research original research that addresses prevalence, causes, mechanisms, diagnosis, course, treatment, and prevention of lower genital tract disease. We publish clinical guidelines, position papers, cost-effectiveness analyses, narrative reviews, and systematic reviews, including meta-analyses. We also publish papers about research and reporting methods, opinions about controversial medical issues. Of particular note, we encourage material in any of the above mentioned categories that is related to improving patient care, avoiding medical errors, and comparative effectiveness research. We encourage publication of evidence-based guidelines, diagnostic and therapeutic algorithms, and decision aids. Original research and reviews may be sub-classified according to topic: cervix and HPV, vulva and vagina, perianal and anal, basic science, and education and learning. The scope and readership of the journal extend to several disciplines: gynecology, internal medicine, family practice, dermatology, physical therapy, pathology, sociology, psychology, anthropology, sex therapy, and pharmacology. The Journal of Lower Genital Tract Disease highlights needs for future research, and enhances health care. The Journal of Lower Genital Tract Disease is the official journal of the American Society for Colposcopy and Cervical Pathology, the International Society for the Study of Vulvovaginal Disease, and the International Federation of Cervical Pathology and Colposcopy, and sponsored by the Australian Society for Colposcopy and Cervical Pathology and the Society of Canadian Colposcopists.