“即诊即治”法在宫颈上皮内瘤样病变诊疗中的价值

Value of "See and Treat" Method in the Diagnosis and Treatment of Cervical Intraepithelial Neoplasia

目的:探讨"即诊即治"法在宫颈上皮内瘤样病变(CIN)诊疗中的价值。方法:选取2009年5月—2011年12月经宫颈液基薄层细胞学(TCT)检查结果为CIN的已生育患者300例,根据TCT检查结果分为低度病变组(A组)和高度病变组(B组)。A组包括未明确诊断意义的不典型鳞状细胞(ASCUS)、未明确诊断意义的不典型腺上皮细胞(AGUS)、轻度鳞状上皮内瘤变(LSIL)的患者,共162例;B组为重度鳞状上皮内瘤变(HSIL)的患者,共138例。所有患者均行电子阴道镜量化评分系统(RCI)评分,A组采用阴道镜下宫颈组织活检并行宫颈电圈切除(LEEP)术,B组患者采用"即诊即治"法,即行LEEP术,对2组病理结果进行分析。结果:A组阴道镜下宫颈活检的CINⅡ以上检出率与LEEP术后的检出率比较差异无统计学意义(P>0.05)。A组LEEP术后CINⅡ以上病理诊断率为18.52%(30/162),过度治疗率81.48%(132/162)。B组LEEP术后CINⅡ以上病理诊断率为80.43%(111/138),过度治疗率19.57%(27/138);对B组患者,RCI评分诊断CINⅡ以上的敏感度为84.68%(94/111),特异度81.48%(22/27),阳性预测值94.94%(94/99),漏诊率15.31%(94/111),过度治疗率5.05%(5/99)。结论:对于TCT检查为宫颈高度病变、阴道镜RCI高评分的患者,采用"即诊即治"方法诊疗可减少过度治疗和漏诊。

Objective ：To evaluate the application of the ＂see and treat＂ approach of the loop electrosurgi- eal excision procedure （LEEP） in women with cervical intraepithelial neoplasia（CIN）. Methods： Three hundred women having childbearing history with cervical intraepithelial neoplasia were included in this study. According to the test of cervical liquid-based cytology （TCT）,cases were divided into two groups,group A （low lesions） and group B （high lesions）. Group A, included 162 cases with atypical squamous cells of undetermined significance （ASCUS）, atypical glandular cells of undetermined significance （AGUS）, low-grade squamous intraepithelial lesion （LSIL） patients. Group B included 138 cases with high-grade squamous intraepithelial neoplasia （HSIL）. All cases were scored by the electronic colposcope quantitative scoring system（RCI）. Cases of group A were treated by the cervical biopsy combined with colposcopy and electrosurgery （LEEP）. Cases of group B were treated by the ＂ see and treat＂ approach of LEEP. Then pathological resuhs were analyzed. Results： There is not significant dif- ference in the CIN I1 detection rates between by cervical biopsy and by LEEP within group A（P〉0.05）. In group A, the pathologic diagnosis of CIN I1, or above, was 18.52%; while the over-treatment rate was 81.48%. In group B, the pathologic diagnosis of CIN II or above was 80.43%, while the over-treatment rate was 19.57%. In group B, if combined with the RCI high score, the diagnosis sensitivity of CIN I1 or above was 84.68%, speci- ficity 81.48%, positive predictive value 94.94%, the omission diagnose rate 15.31%, and the over-treatment rate 5.05%. Conclusions： For those patients with HSIL by TCT and high scores by RCI,the ＂see and treat＂ ap- proach can reduce the over-treatment rate and the omission diagnose rate.