环形电切术活检结合冰冻切片在宫颈上皮内瘤变Ⅲ级诊治中的应用价值

Clinical value of LEEP biopsy combined with frozen section in diagnosis and treatment of cervical intraepithelial neoplasia grade Ⅲ

目的宫颈上皮内瘤变Ⅲ级(CINⅢ级)患者在子宫全切除术前,需应用锥切方法加冰冻切片病检再次评估病变范围。文中旨在探讨在CINⅢ级患者选择子宫全切除术前,采用环形电切术(LEEP)活检结合冰冻切片的方法评估病变严重程度和手术范围的应用价值。方法回顾性分析2011年1月至2012年12月中南大学湘雅二医院妇产科拟切除子宫的CINⅢ级患者168例。分析阴道镜下活检、LEEP活检冰冻切片及石蜡切片和术后残余宫颈病检结果。结果冰冻切片病检结果显示,109例(64.88%)CINⅢ级、37例(22.02%)炎症及CINⅠ-Ⅱ级、22例(13.09%)微灶浸润癌及浸润癌患者与阴道镜活检结果一致。石蜡切片病检结果中,109例(64.88%)CINⅢ级、33例(19.6%)炎症及CINI-II级、26例(15.4%)微灶浸润癌及浸润癌患者与阴道镜活检结果一致。LEEP活检后用冰冻切片与石蜡切片分别进行病检,两者结果的一致率为95.2%,Kappa值=0.912(P=0.000)。146例宫颈LEEP活检为CINⅢ级患者残余宫颈中,75例(51.3%)存在残余病变。比较宫颈阴道镜活检与最终诊断,阴道镜活检漏诊26例浸润癌。结论 LEEP活检术结合冰冻切片,在CINⅢ级患者选择子宫全切除术前能够提供快速、准确的评估,根据冰冻切片病检决定手术范围是可行的。

Objective Cold knife conization combined with frozen section were usually used in assessing the severity of the disease and the scope of the operation in cervical intraepithelial neoplasia class Ⅲ( CINⅢ) patients before the total hysterectomy. In this study,LEEP biopsy combined with frozen section was used for preoperative assessment in CINⅢ patients. The clinical value of this approach in assessing disease severity and operation scope before total hysterectomy will be analyzed. Methods We retrospectively analyzed the results of colposcopy biopsy,LEEP biopsy frozen sections,paraffin sections and postoperative residual cervix pathological biopsy in 168 cases with CINⅢ admitted to our hospital from January 2011 to December 2012. Results LEEP biopsy combined with frozen sections showed that 64. 88%( 109/168) results of frozen section were consistent with the results of cervical colposcopy biopsy,22.02%( 37/168) were degraded and 13. 09%( 22/168) were upgraded to microfocal invasive cancer or invasive cancer.The pathological results of paraffin section showed that 109 cases( 64.88%) of CINⅢ lever,33 cases( 19.6%) of inflammatory and CINⅠ-Ⅱ,26 cases( 15. 4%) of micro invasive carcinoma and invasive carcinoma were consistent with the results of cervical colposcopy biopsy. The accuracy of LEEP frozen biopsy was 95.2%( κ = 0). Among the 146 residual cervixs of CINⅢ patients diagnosised by LEEP biopsy,51.3%( 75/146) had pathological changes.Comparison of cervical colposcopy biopsy and final diagnosis,26 cases of invasive cancer were missed diagnosis by cervical colposcopy biopsy. Conclusion LEEP biopsy combined with frozen section can provide a quick and accurate assessment before cystectomy in CINⅢ patients. It is feasible to determine the surgical range according to frozen section biopsy.