宫颈CINⅠ活检与LEEP术后病理分级差异及其影响因素的相关性分析

Histopathology Differences between Colposcopy Multiple Biopsies and Cervical LEEP Conization in CINⅠ

目的:通过回顾性分析宫颈上皮内瘤变(CIN)Ⅰ患者阴道镜多点活检与宫颈环形电切术(LEEP)后组织病理学分级的差异及其相关因素,为合理和个性化治疗CINⅠ提供依据。方法:选择2007年7月至2012年8月于上海交通大学医学院附属仁济医院妇科门诊就诊经宫颈多点活检病理证实并接受LEEP的CINⅠ患者123例,LEEP术前统一采集宫颈脱落细胞标本行液基薄层细胞学(TCT)检查、人乳头瘤病毒(HPV)分型检测和hTERC基因检测,研究其LEEP术后病理学分级与年龄、孕次等一般资料和TCT分类、HPV分型及hTERC基因的相关性。结果:①123例CINⅠ患者LEEP术后确诊为宫颈黏膜慢性炎(NILM)76例,CINⅠ29例,CINⅡ14例,CINⅢ3例,宫颈早期微浸润癌1例。②LEEP术后病理分级与术前TCT细胞学分类呈正相关(r=0.236,P=0.008)。TCT检查为不典型鳞状上皮细胞(ASCUS)或正常范围的宫颈上皮细胞(阴性)共81例,而LEEP术后病理检查为NILM 57例(70.4%);TCT检查为LSIL 31例,LEEP术后病理检查为NILM和CINⅠ25例(80.6%),CINⅡ6例(19.4%),未发现CINⅢ及以上病例。③LEEP术后病理分级与患者的年龄、妊娠次数、分娩方式及术前HPV感染、HPV感染亚型(HPV16/18)和术前hTERC基因异常扩增均无相关性(P>0.05)。结论:宫颈细胞学检查结果可作为阴道镜下活检为CINⅠ患者是否需要切除性治疗的参考指标,低级别宫颈细胞学异常可能提示该类人群良好的预后倾向。

Objective： We reviewed histopathological differences between colposcopy multiple biopsies and cervical LEEP conization in 123 patients with cervical intraepithelial neoplasia I （ CIN I ）, with the aim to find some relevant factors to optimize the diagnostic procedure and treatment of CIN I Methods：From July 2007 to August 2012,123 patients of CIN I diagnosed by cervical multi-point biopsy and underwent cervical LEEP coniza- tion in Renji hospital were enrolled in this analysis. All patients got a conventional liquid-based cytology, HPV gen- otyping test and hTERC genetic test using fluorescence in situ hybridization（FISH） before conization. Results：① Among 123 patients with CIN I diagnosed by colposcopy multi biopsy,76 cases of mucosa of chronic inflamma- tion in,29 cases of CIN I ,14 cases of CIN Ⅱ,3 cases of CINⅢ ,and 1 case of early micro-invasive cervical carci- noma were confirmed by LEEP conization pathology. ②There was a positive correlation（ r =0. 236, P =0. 008）be- tween LEEP conization pathology and cervical cytology test before LEEP. 57 cases diagnosed ASC or NILM were affirmed no lesion by conization pathology（70. 4% ,57/81 ）. 25 cases diagnosed LSIL were affirmed no lesion or low grade lesion（80. 6% ,25/31 ）. ③The statistics showed no significant difference（ P 〉 0. 05）in age, number of pregnancy, maternity case, mode of delivery and other indicators in different groups of pathological results after LEEP. The statistics showed no significant difference（ P 〉0. 05） in HPV infection, HPV genotypes and hTERC ge- netic testing in different groups of pathological results after LEEP. Conclusions：Cervical cytology results can beused as a reference index for diagnosis and treatment of CIN I , and low-grade cervical cytological abnormalities may indicate a better prognosis.