阴道镜下多点活检联合宫颈管诊刮术在宫颈上皮内瘤变诊断中的价值

The value of diagnosis in cervical intraepithelial neoplasia with colposcopically directed biopsy plus endocervical curettage

目的评价阴道镜下宫颈多点活检联合宫颈管诊刮术(联合法)诊断宫颈上皮内瘤变(CIN)的价值。方法回顾性分析近2年联合检查法诊断为CIN,并于短期内行宫颈环形电切术(LEEP)的43例患者的临床病理资料,采用自身对照对比研究联合法和LEEP术后病理诊断的一致性,并分析联合法的临床价值。结果 43例患者联合法病理诊断同LEEP诊断符合者72.0%(31/43),其中诊断过度者为13.9%(6/43),诊断不足者为13.9%(6/43)。联合法诊断CINⅠ共5例,LEEP术后证实CINⅡ-Ⅲ2例;诊断CINⅡ-Ⅲ共38例,LEEP术后证实宫颈浸润癌4例,漏诊率10.5%。细胞学检查结果为ASCUS-H及以上者阴道镜下活检浸润性宫颈癌的漏诊发生率显著高ASCUS者(P<0.05)。结论联合法诊断CIN具有微创、可重复性高及低漏诊率的特点;对于细胞学检查为ASCUS-H及以上的患者应反复筛查,以降低宫颈浸润癌的漏诊率。

Objective To evaluate the value of colposcopically directed biopsy plus endocervical curettage （ for short： combination method） in the diagnosis of cervical intraepithelial neoplasia （ CIN） .Methods The clinical data of 43 patients with CIN diagnosed by combination method and then treated with cervical loop electrosurgical procedure （ LEEP） were retrospectively studied.The consisten-cy of pathological examination between combination method and LEEP was evaluated.The factors of missed diagnosis of cervical invasive carcinoma were analyzed.Results The diagnosis of 31 out of the 43 patients by combination method consistent with that by LEEP patho-logic diagnosis with a consistence rate of 72.0% ,however,the diagnoses of 12 of the 43 patients by combination method were not con-sistent with those by LEEP,including 6 cases of over diagnosis （ 13.9% ,6 /43） and 6 cases of under diagnosis （ 13.9% ,6/43） .Four patients were confirmed as with cervical invasive carcinoma by LEEP at last with a missed diagnosis rate of 10.5% .The missed diagno-sis rate of invasive carcinoma by combination method was significantly higher in the patients with cytological diagnosis of with≥ASCUS-H than in the patients cytologiccally diagnosed as withASCUS-H（ P0.05） .Conclusions Combination method diagnosis CIN has benefit of microtrauma and repeatablity and low missed features.The patients with cytological diagnosis of≥ASCUS-H need repeated inspection in order to avoid missed diagnosis of cervical carcinoma.