阴道镜指引下多点活检遗漏子宫颈浸润癌14例临床分析

Clinical analysis of 14 invasive cervical carcinoma missed in colposcopy-directed cervical biopsy

目的通过分析阴道镜指引下多点活检(CDB)遗漏子宫颈浸润癌患者的资料,探讨阴道镜活检后患者的管理模式。方法 645例CDB病理诊断为宫颈上皮内瘤变(CIN)2及以上病变(CIN2+)患者行子宫颈锥切术,对比锥切术前后的病理结果及14例遗漏的子宫颈浸润癌患者的年龄、筛查结果、阴道镜诊断、病变范围及是否向颈管内延伸等临床资料。结果 CDB病理诊断CIN2+的敏感度为95.0%,特异度为46.2%,子宫颈锥切术前后CIN2/3病理诊断的一致性为71.4%(450/630),宫颈浸润癌遗漏率为2.2%(14/630)。14例遗漏子宫颈浸润癌患者的平均年龄为(43.4±8.7)岁,其中10例筛查结果为高级别病变,11例HPV高危亚型感染(10例为HPV16),12例阴道镜诊断为HSIL+,9例病变范围超过子宫颈面积的50%,13例CDB病理结果为CIN3,10例宫颈锥切术后病理结果提示切缘不净。结论阴道镜指引下多点活检是诊断CIN2/3的一种简单而有效的方法,但可遗漏少部分子宫颈浸润癌。对于病理诊断CIN2/3者建议行子宫颈锥切术进一步诊断及治疗。

Objective To analyze the data of patients with invasive cervical carcinoma that were missed in colposcopy-directed cervical biopsy （CDB） and summarize management model after colposcopy biopsy. Methods 645 cases who were diagnosed as CIN2 and higher level lesions （CIN2＋） with CDB underwent cervical conization surgery. We compared pathology results before and after conization, analyzed and summarized the clinical data of 14 invasive cervical cancer cases missed under the guidance of colposcopy biopsy, including patients age, screening results, colposcopy diagnosis, extent of disease, and whether to extend into the cervical canals. Results The sensitivity of CDB pathological diagnosis of CIN2＋ was 95.0% and the specificity was 46.2%, the pathological diagnosis consistency before and after cervical conization for CIN2/3 was 71.4% （450/630）, the miss rate of invasive cervical carcinoma missed was 2.2% （ 14/630）. The average age of these patients was （43.4-＋ 8.7） years old, l0 cases were screened for high levels of abnormal cytology results, 11 cases were infected with high-risk HPV subtypes, of which 10 cases for subtype HPV16 infection, 12 cases were diagnosed with colposcopy for HSIL＋, 9 patients with the lesion area more than 50% of the cervical areas, 13 patients＇ CDB pathology results were CIN3, l0 cases who with positive margin after conization surgery. Conclusions CDB is a simple and effective diagnosis method for CIN2/3, but may miss 2.2% of invasive cervical carcinoma. It suggested that cervical conization surgery is necessary for further diagnosis and treatment with regard to CIN2/3 with CDB.