宫颈联合筛查漏诊CINⅢ级及以上病变的危险因素分析

Analysis of risk factors for missed diagnosis of CINⅢor above lesions by combined cervical screening

目的探讨薄层液基细胞学检查(thinprep cytologic test,TCT)、高危型人乳头状瘤病毒(high-risk human papillomavirus,HR HPV)和阴道镜联合检查漏诊组织学病检≥宫颈上皮内瘤变Ⅲ级(cervical intraepithelial neoplasiaⅢ,CINⅢ)者的危险因素分析。方法对296例阴道镜活检组织学诊断为≥宫颈高级别鳞状上皮内病变(high grade squamous intraepithelial lesion,HSIL)/CINⅢ者的临床资料进行回顾性分析。结果以阴道镜下组织学活检的病理诊断为准,其中TCT+阴道镜联合检查诊断≤LSIL(诊断不足)者81例,占比27.4%,TCT+阴道镜联合检查诊断≥HSIL(诊断相符)者215例,占比72.6%,296例患者中高危型HPV阳性者294例,阴性者2例。将诊断相符和不相符的患者按照年龄分组绘制曲线图,发现51岁~64岁组的患者诊断相符率明显低于其他组,诊断不相符率亦明显高于其他组。对患者HR-HPV型别、绝经与否、阴道镜下转化区是否完全可见这3个非特异性因素进行统计学分析,结果显示,不同HR-HPV型别对TCT+阴道镜联合诊断的准确性的影响无统计学意义(P>0.05),是否绝经和阴道镜下转化区是否完全可见对TCT+阴道镜联合诊断的准确性的影响均具有统计学意义(均P<0.05)。结论51岁~64岁的未绝经、阴道镜下转化区不完全可见患者TCT+阴道镜联合诊断的准确性较低,临床上需要特别注意。

Objective To investigate the risk factors of missed diagnosis of histological examination≥CINⅢby thinprep cytologic test(TCT),HR-HPV and colposcopy.Methods The clinical data of 296 patients with colposcopic biopsy diagnosed as≥HSIL/CINⅢwere retrospectively analyzed.Results Based on the pathological diagnosis results of histological biopsy under colposcopy,there were 81 cases diagnosed by joint examination of TCT and colposcopy as≤LSIL(under-diagnosed),accounting for 27.4%,and 215 cases diagnosed by joint examination of TCT and colposcopy as≥HSIL(accurately diagnosed),accounting for 72.6%.Among them,there were 294 cases of positive HR-HPV and 2 cases of negative HR-HPV.Accurately diagnosed patients and under-diagnosed patients were plotted by age,and the diagnostic compliance rate in 51-64-year-old group was significantly lower than that in the other groups.The diagnostic inconsistency rate was also significantly higher than that in the other groups.Statistical analysis was performed on the three non-specific factors:HR-HPV type,menopause situation and visibility of conversion area under the colposcopy.The results showed the effect of different HR-HPV types on the accuracy of joint diagnosis of TCT and colposcopy was not statistically significant(P>0.05).Menopause situation and the visibility of conversion area under the colposcopy had a statistically significant effect on the accuracy of combined diagnosis of TCT and colposcopy(all P<0.05).Conclusions The accuracy of joint diagnosis of TCT and colposcopy in patients with non-menopausal and incomplete visibility of conversion zone in 51-64 years old patients is low,and special attention should be paid in clinical work.