活检组织快速石蜡切片病理检查在子宫颈病变诊治中的应用

Application of pathological diagnosis by rapid paraffin sections for biopsy in the diagnosis and treatment of cervical diseases

目的评价活检组织快速石蜡切片病理检查在宫颈病变诊治中的应用价值。方法选择2009年9月至2010年1月在山东大学齐鲁医院行宫颈癌筛查异常者（包括细胞学检查异常及高危型HPV持续阳性）共176例，随机分为两组。A组：87例，首先采用宫颈Belinson活检钳在阴道镜指示下行宫颈多点活检，然后利用超声组织处理仪和BT生物组织透明剂制作快速石蜡切片，行病理检查；B组：89例，在阴道镜指示下行宫颈多点活检，制作常规石蜡切片，行病理检查。比较两组的切片质量、制片时间。对A、B组中诊断为宫颈上皮内瘤变（CIN）Ⅱ及以上病变、特殊情况的CINⅠ患者行手术治疗，手术方式包括宫颈环形电极切除术（LEEP）、宫颈冷刀锥切术（CKC）、子宫切除术或宫颈癌根治术，手术标本术后进行常规病理检查，当活检组织（包括快速或常规）病理检查和术后标本常规病理检查结果不符时，以两者中诊断结果较重者为最终诊断，比较A、B组的活检组织病理检查结果与最终诊断的符合率。结果A、B组切片质量均为满意或基本满意，能够满足诊断要求，切片合格率均为100％。A、B组的制片时间平均分别为40min和1d，两组比较，差异有统计学意义（P〈0．05）。A、B组中行手术治疗的患者分别为30、32例，其活检组织病理检查结果与最终诊断的符合率分别为93％（28／30）和91％（29／32），两组比较，差异无统计学意义（P〉0．05）。结论活检组织快速石蜡切片病理检查诊断宫颈病变准确可靠、快速经济，有推广使用价值。

Objective To evaluate the application of pathological diagnosis by rapid paraffin sections in the diagnosis and treatment of cervical diseases. Methods A total of 176 cases from our hospital between September 2009 and January 2010 with abnormal cervical cancer screening （including abnormal cytology result and high-risk HPV continuous positive） were randomly divided into 2 groups. Eighty-seven cases of them whose biopsy were got by Belinson forceps under the direction of colposcopy with rapid paraffin sections by ultrasonic histopathological rapid processor and BT transparent agents were selected as group A, while 89 cases with conventional paraffin sections were selected as group B. The production time and quality for paraffin sections were analyzed in the two groups. Those diagnosed as cervical intraepithelial neoplasia （CIN） Ⅱ or even worse and some special patients with CIN I in the two groups received surgery, including loop electrosurgical procedure （LEEP） , cold knife eonization （CKC）, hysterectomy or radical hysterectomy. Tissue obtained after surgery was sent for routine pathological examination. If the results of postoperative routine pathological examination were inconsistent with the rapid or routine biopsy pathological examination, the heavier results were regard as the final diagnoses. The pathological results and diagnose accordance rateswere recorded and compared between group A and group B. Results The quality of sections in two groups were all satisfied or basically satisfied to meet the diagnostic requirements. There were statistically significant difference in average production time between group A and B （40 minutes vs 24 hours, P 〈 0. 05 ）. Thirty patients in group A and 32 patients in group B received surgery. The coincidence rate of biopsy pathological results and final diagnoses were 93% （28/30） for group A and 91% （29/32） for group B, in which there were not statistically significant difference （P 〉 0. 05 ）. Conclusion Rapid paraffin sections technology is safe, accurate and economical for rapid pathological diagnosis of cervical diseases, which is worthy for being widely used in hospitals.