阴道镜指导下宫颈活检诊断宫颈上皮内瘤变准确性评估

Evaluation of accuracy of cervical biopsy in diagnosing CIN Ⅰ

目的评价阴道镜指导下宫颈活检诊断宫颈上皮内瘤变Ⅰ级(CINⅠ)的准确性。方法回顾阴道镜活检诊断为CINⅠ并于短期内行宫颈环形电切术(LEEP)235例患者的临床及病理资料,分析阴道镜下宫颈活检诊断不足及漏诊宫颈浸润癌的相关因素。结果 235例患者中,阴道镜下宫颈活检诊断结果与最终诊断符合者152例(64.7%),诊断过度者29例(12.3%),诊断不足者46例(19.6%)。8例患者最终诊断为宫颈浸润癌,漏诊率为3.4%。结论对细胞学检查结果为非典型鳞状上皮不排除高度病变、高度鳞状上皮内瘤变或阴道镜检查不满意者,阴道镜下宫颈活检确诊为CINⅠ尚不够可靠,需警惕漏诊。

Objective To evaluate the accuracy of cervical biopsy under the guidance of colposeopy in diagnosing cervical intraepithelial neoplasia grade Ⅰ （CIN Ⅰ）. Methods Clinical and pathological data from 235 patients with CIN Ⅰ diagnosed by biopsy under the guidance of colposcopy were retrospectively analyzed, who were given cervical loop electrosurgical excision procedure （LEEP）. Results Of 235 cases,the diagnosis of biopsy was accordant with that of final pathology in 152 cases（64.7%） ,overdiagnosed in 29 eases（12. 3%） ,deficient diagnosed in 46 eases（19.6%） ,and 8 cases was finally diagnosed as cervical invasive cancer with the missing diagnosis rate of 3.4 %. Conclusion In case of cytology results of atypical highgrade squamous intraepithelial lesion（ASC-H） or highgrade squamous intraepithelial lesions（HSIL）, or unsatisfactory colposcopy, a diagnosis of CIN Ⅰ by biopsy under the guidance of colposcopy may not be reliable and the vigilance should be taken to avoid missing diagnosis.