阴道镜下宫颈活检和宫颈环形电切术后病理检查对宫颈癌前病变的诊断价值

Diagnostic value of cervical biopsy under colposcope and pathological examination after loop electrosurgical excision procedure on cervical intraepithelial neoplasia

目的探讨阴道镜下宫颈活检和宫颈环形电切术(LEEP)后病理检查对宫颈癌前病变的诊断价值。方法对380例经宫颈细胞学检查(TCT)和/或人乳头状瘤病毒(HPV)检测异常,或上述筛查正常但肉眼观察到宫颈柱状上皮中重度外翻的患者,行阴道镜下宫颈活检及LEEP术,比较两者诊断的符合率。结果阴道镜下宫颈活检与LEEP术后病检的总符合率为65.00%(247/380),镜下活检诊断为CINⅠ级者经LEEP术后升级为CINⅡ/Ⅲ级的占10.59%(9/85),诊断为CINⅡ/Ⅲ级及原位癌者经LEEP术后诊断升级为微小浸润癌的占11.40%(13/114)。2种诊断方法与联合诊断的最终病理结果比较,阴道镜下宫颈活检的总符合率为80.79%(307/380),LEEP术后病检的总符合率为84.21%(320/380)。结论阴道镜宫颈活检可以有效诊断宫颈癌前病变,但可能存在漏诊微小浸润癌的风险,联合使用阴道镜宫颈活检和LEEP术,可以提高诊断准确性。

Objective To investigate the diagnostic value of cervical biopsy under colposcope and pathological examination after loop electrosurgical excision procedure（ LEEP） on cervical intraepithelial neoplasia（ CIN）. Methods A total of 380 patients,with abnormal detection of thinprip cytologic test（ TCT） and /or human papillomavirus（ HPV） or with macroscopic moderate and severe exstrophy of cervical columnar epithelium even if TCT and /or HPV were normal,were given cervical biopsy under colposcope and LEEP. The diagnostic accordance rate of two detection methods was compared. Results The total diagnostic accordance rate of two group was 65. 00%（ 247- 380）,in which the rates of patients diagnosed with CINⅠ and CIN Ⅱ /Ⅲ combined with carcinoma in situ by cervical biopsy under colposcope but with CIN Ⅱ /Ⅲ and carcinoma with micro- infiltration under LEEP were10. 59%（ 9 /85） and 11. 40%（ 13 /114）,respectively. Compared with the terminal pathological results of combined detection,the total diagnostic accordance rates of cervical biopsy under colposcope and LEEP were 80. 79%（ 307 /380） and 84. 21%（ 320 /380）,respectively. Conclusion Cervical biopsy under colposcope can effectively diagnose CIN but with the slight risk of misdiagnosing micro-infiltration,and its combination with LEEP can apparently improve diagnostic accuracy.