宫颈细胞学与阴道镜活检组织学诊断一致性分析

Consistency of diagnosis between cervical cytology and coiposcopic biopsy diagnosis

目的探讨宫颈疾病患者细胞学检查为阳性而组织学未发现阳性病灶的现况及原因。方法以低级别鳞状上皮内病变及以上为细胞学阳性标准，收集2008至2016年复旦大学附属妇产科医院病理科细胞学诊断阳性的病例12097例，首次活检阴性3107例，其中675例复核活检，细胞学与组织学活检诊断的一致性采用Kappa值表示。结果首次活检的总阳性率为74．3％（8990／12097），首次活检阴性经复核活检证实确有病变287例（42．5％，287／675），患者的年龄明显大于首次活检阳性的患者，且再次送检标本类型较初次送检切取范围更广，包括更多比例的阴道壁活检、锥切活检和全子宫切除标本。复核原细胞学结果，最终阳性组织学诊断与初始细胞学诊断具有一定的相关性，Kappa值为0．505（P〈0．01）。结论合格的宫颈细胞学诊断是活检组织学的有益补充且一致性较好，在活检阴性时不能忽略初始细胞学阳性结果。在细胞学与活检组织学结果不符的病例中，重复阴道镜活检以及适当扩大活检范围有助于发现隐匿的宫颈病变。

Objective To identify underlying reasons for discrepant cases of positive cytology but negative histology. Methods Cases with positive cytology and negative histology from 2008 to 2016 were retrieved from Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University. Low grade squamous intraepithelial lesion or higher grade lesions were considered as positive cytology test in the study. Consecutive follow-up biopsies and as well as sites of biopsy were documented for analysis. Results Overall positive rate of biopsy followed positive cytology was 74. 3% （8 990/12 097）. Of the negative biopsies, 675 cases were followed-up with multiple biopsy. Two-hundred and eighty-seven cases （42. 5%,287/675） were confirmed to have lesions. Comparing with those with initial positive biopsiews, patients of the latter group were significantly older and had other specimen types including vaginal biopsy, cone biopsy and hysterectomy. The final histological diagnoses were well correlated with cytological results （ Kappa = 0. 505, P〈0. 01 ）. Conclusions Qualified cervical cytology is complimentary to histological diagnosis. Clinicians should not ignore the positive cytological result prior to a normal histological diagnosis. In contradictory cases, repeated colposcopy and biopsy at extended anatomic sites may reveal additional lesions.