阴道镜下四象限活检在宫颈癌筛查诊断中的应用价值

Value of applications of four-quadrant biopsy by colposcopy for diagnosing cervical cancer

目的:探讨阴道镜下四象限活检在宫颈癌筛查诊断中的应用价值。方法:回顾性分析本院2015年1月-2016年6月收治的宫颈液基薄层细胞学检查(TCT)阳性患者150例的临床资料,所有研究对象均行阴道镜检查,对阴道镜检查阳性者均行镜下四象限活检,对镜下发现可疑病灶者取病灶组织活检。对检查阳性者手术治疗,以术后病理结果为最终诊断。结果:阴道镜检查阴性为48例(32.0%),阳性102例(68.0%);术后病理检查阴性为55例(36.7%),阳性为95例(63.3%);阴道镜与术后病理诊断结果的一致率为87.3%。阴道镜下四象限活检与术后病理活检诊断高度鳞状上皮内病变(LSIL)、低度鳞状上皮内病变(HSIL)、浸润癌的符合率分别为71.4%、81.6%、100.0%,阴道镜下可疑病变活检诊断LSIL、HSIL、浸润癌的符合率分别为68.2%、73.7%、88.2%。宫颈癌诊断符合率高于LSIL及HSIL(P<0.05),且阴道镜下四象限活检诊断LSIL以上病变的符合率高于阴道镜下可疑病变活检(P<0.05)。阴道镜下四象限活检诊断宫颈癌的灵敏度、准确度及阳性预测值(91.7%、98.0%、100.0%)均较阴道镜下可疑病变活检高(P<0.05)。结论:阴道镜下四象限活检对宫颈癌的早期筛查诊断具有较高价值,能提高宫颈癌检出率及诊断准确性。

Objective： To investigate the application values of colposcopic four-quadrant biopsy for diagnosing cervical cancer. Methods： A retrospective study was conducted to analyze the clinical data of 150 patients with positive result by cervical thinprep cytologic test （TCT） from January 2015 to June 2016 in Affiliated Hospital of Nankai University. All patients were further checked by colposcopy checked, cervical four-quadrant biopsy under colposcopy or suspicious le- sions biopsy under colposcopy, and tissue from biopsy was further pathological determined. The patients with patho- logical positive result of biopsy tissue had been operated for removing lesions tissue. And postoperative pathological re- sult was the final diagnosis. Results.. 48 cases （32.0%） had negative results and 102 cases （68.0 %） had positive results by colposcopy checked. The negative rate of postoperative pathology was 36.7 % （55 cases）, and 95 cases （63.3 %） were positive pathological results. The coincidence rate diagnosed by colposeopic biopsy and postoperative pathology was 87.3 %. Among them, the coincidence rate of diagnosed LSIL, HSIL and invasive carcinoma by four-quadrant bi- opsy under colposcopy and by postoperative pathology were 7].4%, 81.6% and 100%, respectively. The coincidence rate of diagnosed LSIL, HSIL and invasive carcinoma by suspicious lesions biopsy under colposcopy and postoperative pathology were 68.2 %, 73.7 %, 88.2%, respectively. The rate of diagnostic accuracy of cervical cancer was higher than that of LSIL and HSIL （P〈0.05）. The coincidence rate of diagnosis LSIL and above LSIL by four quadrant biopsy un- der colposcopy was higher than that by suspicious lesions biopsy under colposcopy （P〈0.05）. The sensitivity, accura- cy and positive predictive value （91.7 %, 98.0 %, 100.0 %） of four-quadrant biopsy under colposcopy for diagnosing cervical cancer were significantly higher than those of suspicious lesions biopsy under colposcopy （P〈0.05）. Conclusion： Four-quadrant biopsy under colposcopy has great value in the early screening of cervical cancer, which can im- prove the detection rate and diagnostic accuracy of cervical cancer.