阴道镜指引下多点活检检测老年早期子宫颈癌的临床效果

The value of colposcopic biopsy on the early diagnosis of cervical carcinoma

目的探讨阴道镜指引下多点活检检测早期子宫颈癌的临床效果。方法 412例人乳头瘤病毒(HPV)检测及宫颈细胞学检测异常的患者,行阴道镜指引下多点活检及子宫颈环形电切术(LEEP),回顾性分析患者LEEP手术前后病理变化,采用自身对照对比阴道镜指引下多点活检诊断结果和最终病理结果。结果阴道镜指引下多点活检诊断结果与LEEP手术后病理诊断结果相符者336例(86.94%),其中29例(7.04%)诊断不足,10例(2.43%)诊断过度。阴道镜指引下多点活检诊断慢性宫颈炎与病理结果一致性比较Kappa值为0.75,扁平湿疣/疣样病变诊断Kappa值0.65,子宫颈上皮内瘤变(CIN)Ⅰ诊断Kappa值0.78,CINⅡ/Ⅲ诊断Kappa值0.77,原位癌诊断Kappa值0.69,微小浸润癌诊断Kappa值0.75。本次研究样本中最终13例诊断为宫颈浸润癌,漏诊率为23.08%,对CINⅡ/Ⅲ级的漏诊率为7.65%,CINⅠ漏诊率7.50%,扁平湿疣/疣样病变漏诊率36.36%,慢性宫颈炎漏诊率9.95%。细胞学检查示高度鳞状上皮内病变(HSIL)及以上者阴道镜指引下多点活检的漏诊率23.61%,显著高于低度鳞状上皮内病变(LSIL)及以下者2.15%(χ~2=8.643,P<0.05)。结论阴道镜指引下多点活检是早期诊断宫颈癌的有效方法,但其有可能漏诊高级别的宫颈癌及宫颈微小浸润癌。

Objective To investigate the value of coiposcopic biopsy on the early diagnosis of cervical carcinoma. Methods 412 patients with abnormal exam results in cervical cytology and（or） human papillomavirus （HPV） test were enrolled,and all of them got colposcopic cervical biopsy and LEEP. The pathological diagnosis was compared before and after LEEP. Results The total coincidence number of colposcopic cervical biopsy and pathology by LEEP was 336 （86.94%）, and 29 patients （7.04%） suffered under-diagnosis and 10 patients （2.43 % ） were over-diagnosis. The Kappa of diagnosis of chronic cervicitis, condyloma, CIN Ⅰ , CIN Ⅱ / Ⅲ, carcinoma in situ and microinva- sive cervical carcinoma were 0. 75 ,0.65,0.78,0.77,0.69,0.75 respectively. The misdiagnosis rates of chronic cervicitis,condyloma,CIN Ⅰ , CIN Ⅱ/Ⅲ, carcinoma in situ and microinvasive cervical carcinoma were 9.95% ,36.36%, 7.50%, 7.65%, 23.08% respectively. Con- clusions Colposcopic cervical biopsy is an effective measure for diagnosis of CIN and microinvasive cervical carcinoma. But colposcopic cervical biopsy might misdiagnose high-level CIN and microinvasive cervical carcinoma.