阴道镜下醋酸白色上皮的病理分析

Pathological analysis of acetowhite epithelium during colposcopy

目的探讨阴道镜下醋酸白色上皮与宫颈上皮内瘤变(CIN)的相关性。方法回顾性分析163例阴道镜异常图像的活检结果。结果在105例醋酸白色上皮处行活检,CINⅠ级(包括宫颈湿疣)21例(20．0％), CINⅡ级4例(3．8％),CINⅢ级1例(1．0％),宫颈炎79例(75．2％)。58例阴道镜下未发现醋酸白色上皮而在其他阴道镜异常图像处活检,仅发现CINⅠ级1例(1．7％),其余均为宫颈炎。醋酸白色上皮诊断CIN的敏感度为96．3％,特异度为41．9％。薄醋酸白色上皮中,84．3％者为宫颈炎;而厚醋酸白色上皮中,75．0％者为CIN。阴道镜下宫颈炎多表现为单一醋酸白色上皮,占60．8％,CIN表现为两联征(醋酸白色上皮+镶嵌或点状血管)占53．9％,三联征(醋酸白色上皮+镶嵌+点状血管)占15．4％。醋酸白色上皮与CIN呈正相关(r=0．47,P<0．001)。醋酸白色上皮中,碘试验均异常,碘不均质着色处活检多为宫颈炎,占95．9％;碘不着色处宫颈炎占61．5％,余为CINⅠ;而碘混合性不着色中,68．4％为CINⅠ,26．3％为CINⅡ～Ⅲ,宫颈炎仅占5．3％。碘试验异常与CIN呈负相关(r=-0．32,P<0．001)。结论阴道镜下醋酸白色上皮与CIN密切相关,结合碘试验,可减少不必要的活检,并提高活检的准确性。

Objective To appraise the relationship of acetowhite epithelium with cervical intraepithelial neoplasia （CIN）under colposcopy. Methods The pathological results of 163 biopsies in abnormal colposcopy were analyzed retrospectively with emphasis on the outcomes of 105 biopsies. Results There were 21 CIN Ⅰ （included condyloma, 20.0%）, 4 CIN Ⅱ （3.8%）, 1 CIN Ⅲ （1.0%）and 79 chronic cervicitis（75.2%）in the 105 biopsies of acetowhite epithelium. In 58 control, no acetowhite epithelium was found during coloposecpy with only 1 CIN Ⅰ , and all others were chronic cervicitis. For CIN, the sensitivity of acetowhite epithelium during colposcopy was 96.3%, and the specificity 41. 9%. 84. 3% chronic cervicitis occurred with thin acetowhite epithelium while 75.2% were CIN for thick acetowhite epithelium. Of the 79 chronic cervicitis, 48（60. 8%）manifested as acetowhite epithelium solely, whereas that of CIN showed punctation and/or mosaic pattern, including 15.4 % for the former and 53.8% for the latter. The iodine test was abnormal in all acetowhite epithelium cases. Heterogenous iodine staining were mostly for chronic cervicitis（95.9%）. In non-iodine staining, 61.50% were chronic cervicitis, the others were CINⅠ with mixed non-iodine staining. More than 50.0% were CIN, among them, 68.4% were CIN Ⅰ, 26.3% caused by CIN Ⅱ-Ⅲ and only 5.3% due to chronic cervicitis. Conclusion The finding of acetowhite epithelium during colposcopy is closely correlated with CIN. With combined iodine staining test, unnecessary biopsies could be avoided with increase of biopsy accuracy. （Shanghai Med J, 2007, 30：104-106）