不同活检方法在子宫颈癌筛查低级别异常管理中的作用

Role of different biopsy methods in the management of women with low level of abnormality in cervical cancer screening

目的探讨人群子宫颈癌筛查低级别异常妇女的管理模式。方法 2014年1至6月在我国北京、河北、陕西的3个县对344例筛查低级别异常者妇女全部行阴道镜检查,并在阴道镜指引下行定位活检/随机活检及子宫颈管搔刮术(ECC),并对不同活检方法 CIN2+的检出进行评估,探讨不同活检方式在筛查低级别异常者CIN2+检出中的作用。结果阴道镜下活检共检出CIN2+病变41例,占11.9%,其中CIN2占9.3%(32/344),CIN3占2.6%(9/344),无浸润癌检出。不同细胞学结果间CIN2、CIN3的检出率比较差异有统计学意义(χ2=11.236,P=0.011)。不同转化区类型中CIN2+的检出率比较差异有统计学差异(χ2=5.769,P=0.009)。不同阴道镜的拟诊中CIN2+的检出率比较差异有统计学差异(χ2=85.986,P=0.000)。在阴道镜指引下,于子宫颈最异常处第1块活检检出CIN2占78.0%(32/41);于病变第2异常处活检额外检出1例CIN2+,占2.4%(1/41);于病变异常处的2块定位活检检出CIN2+的敏感性为80.5%,特异性为88.1%。随机活检额外检出8例CIN2+,占19.5%(8/41),其额外检出CIN2+病变敏感性为19.5%,特异性为90.2%,ECC无额外CIN2+的检出。结论在人群子宫颈癌筛查低级别异常者的管理中阴道镜的评估及诊断非常重要,对于阴道镜下可疑病变部位行阴道镜指引下的2点或以上活检为CIN2+检出的主要方法;对于阴道镜下未发现异常的妇女尚无必要常规行随机活检及ECC。

Objectve To explore the management mode for women with low level of abnormality in cervical cancer screening. Methods From January to June in 2014,a total of 344 cases of women with low level of abnormality in cervical cancer screening received colposcopy.All these women came from three counties in Beijing,Hebei Province and Shaanxi Province. They also underwent locating biopsy / random biopsy as well as endocervical curettage（ ECC） directed by colposcope. The results of cervical intraepithelial neoplasia（ CIN） 2 ＋detection with different biopsy methods were evaluated so as to explore the role of different biopsy methods in the detection of CIN2 ＋ in women with low level of abnormality in cervical cancer screening. Results A total of 41 cases of CIN2 ＋ were detected under biopsy guided by colposcope,accounting for 11. 9%（ 41 /344）. Among them,CIN2 totaled 32 cases,accounting for 9. 3%（ 32 /344）,9 cases of CIN3,accounting for 2. 6%（ 9 /344）. No infiltrating carcinoma was detected. There was statistical significant difference in the detection rate of CIN2 and CIN3 among different cytology results（ χ2= 11. 236,P = 0. 011）. There was statistically significant difference in the detection rate of CIN2 ＋ among different types of transformation zone（ χ2= 5. 769,P = 0. 009）. Statistical significant difference was also identified in the detection rate of CIN2 ＋ among colposcopy impressions（ χ2= 85. 986,P = 0. 000）. Guided by colposcope,the detection rate of CIN2 obtained from the first colposcopy directed punch biopsy（ CDB） reached 78. 0%（ 32 /41）. Besides,the detection rate of CIN2 ＋ obtained from the second CDB was 2. 4%（ 1 /41）. In addition,the combined sensitivity of two CDBs for CIN2 ＋ was 80. 5%,and the specificity was 88. 1%. Moreover,8 cases（ 8 /41,19. 5%） of CIN2 ＋ were detected by random biopsy. The sensitivity of the random biopsy for detecting additional CIN2 ＋ was 19. 5%,and its specificity was 90. 2%. No additional CIN2 ＋ was detected by ECC.Conclusion In the management of women with low level of abnormality in cervical cancer screening,assessment and diagnosis directed by colposcope is of great importance. Colposcopy directed biopsy at two or more punches of the most suspicious lesions is the major way to detect CIN2 ＋. There is no need for women to receive routine random biopsy and ECC if no abnormality is found under colposcope.