阴道镜拟诊宫颈高级别鳞状上皮内病变与病理诊断偏差的影响因素分析

Analysis of influencing factors of colposcopy for diagnosis of high grade squamous intraepithelial lesions and pathological diagnosis

目的分析阴道镜拟诊宫颈高级别鳞状上皮内病变(high-grade squamaus intraepithelial lesion,HSIL)与病理诊断偏差的相关影响因素。方法回顾性分析2017年8月至2018年8月厦门大学附属第一医院阴道镜下拟诊为HSIL的412例患者的临床资料。对阴道镜拟诊与病理诊断的符合率进行统计,分析影响拟诊准确性的相关因素。结果 412例阴道镜拟诊为HSIL的患者中,病理证实为HSIL的288例,符合率为69.90%,其中诊断不足68例(16.51%),诊断过度56例(13.59%)。绝经前、后患者诊断符合率分别为72.58%和61.76%,差异有统计学意义(P<0.05)。宫颈转化区完全可见与不完全可见患者诊断符合率分别为76.22%和64.76%,差异有统计学意义(P<0.05)。先前细胞学结果在HSIL及以上与HSIL以下患者诊断符合率分别为70.88%和67.72%,差异无统计学意义(P>0.05)。3个不同的阴道镜操作者诊断符合率分别为68.48%、71.13%和70.48%,差异无统计学意义(P>0.05)。从诊断符合率差异有统计学意义的两组中进一步分析诊断不足的原因,发现绝经前、后诊断不足率分别为13.23%和26.47%,差异有统计学意义(P<0.05),而转化区完全可见及不完全可见诊断不足率分别为15.14%及17.62%,差异无统计学意义(P>0.05)。结论患者绝经状态、宫颈转化区类型均影响阴道镜拟诊HSIL的准确性,其中绝经后患者容易出现诊断不足。

Objective To analyze the related factors affecting the deviation of high-grade squamous intraepithelial lesion(HSIL) and pathological diagnosis of cervix. Methods The clinical data of 412 patients with HSIL under the colposcopic examination of the First Affiliated Hospital of Xiamen University from August 2017 to August 2018 were retrospectively analyzed. The coincidence rate of the colposcopy diagnosis and pathological diagnosis was statistically analyzed, and the related factors affecting the accuracy of the diagnosis were analyzed. Results Of the 412 patients who underwent colposcopic diagnosis of HSIL, 288 cases were confirmed by pathology. The coincidence rate was 69.90 %, of which 68 cases were lack of diagnosis(16.51 %), 56 cases were overdiagnosed(13.59 %). The diagnostic coincidence rates of premenopausal and postmenopausal patients were 72.58 % and 61.76 %, respectively, and the difference was statistically significant(P<0.05). The diagnostic coincidence rates of patients with fully visible and incompletely visible cervical transformation were 76.22 % and 64.76 %, respectively, and the difference was statistically significant(P<0.05). The diagnostic accuracy of previous cytology results in patients with HSIL and above and HSIL was 70.88 % and 67.72 %, respectively, and the difference was not statistically significant(P>0.05). The diagnostic coincidence rates of the three different colposcope operators were 68.48 %, 71.13 %, and 70.48 %, respectively, and the difference was not statistically significant(P>0.05). The causes of the diagnosis were further analyzed from the two groups with statistically significant differences in diagnostic coincidence. The pre-menopausal and post-diagnostic rates were 13.23 % and 26.47 %, respectively, and the difference was statistically significant(P<0.05). The rates of complete and incomplete diagnosis were 15.14 % and 17.62 %, respectively, and the difference was not statistically significant(P>0.05). Conclusion The menopausal status and type of cervical transformation area affect the accuracy of colposcopic high-grade squamous intraepithelial lesions, and postmenopausal patients are prone to under-diagnosis.