反射式共聚焦显微镜在生殖器疣诊断中面临的挑战

Challenge of reflectance confocal microscopy in the diagnosis of genital warts

目的:反射式共聚焦显微镜(reflectance confocal microscopy,RCM)是目前用于辅助诊断皮肤疾病的常用方法,可用于诊断生殖器疣,生殖器疣在RCM下的特征并非特异性。本研究旨在探索RCM在生殖器疣诊断中面临的挑战。方法:回顾性研究161例进行RCM检查的临床疑诊为生殖器疣的病例,将RCM结果与75例行组织学检查患者的结果进行比较分析。结果:根据RCM图像,161例患者中的102例(63.35%)被诊断为生殖器疣。通过与组织学诊断对比,75例活体组织检查病例RCM诊断生殖器疣的误诊率为35.48%,漏诊率为20.45%。漏、误诊病例所患疾病主要为鲍温样丘疹病、原位鳞状细胞癌、传染性软疣、假性湿疣及扁平苔藓。经活体组织检查证实的生殖器疣其RCM镜下特征性细胞结构表现为颗粒层或棘层出现的空泡化细胞较正常角质形成细胞体积增大、细胞质呈低折光。结论:生殖器疣与相关疾病的RCM特征存在相似性,部分病例易被误诊或漏诊。RCM镜下诊断性空泡化细胞可作为诊断生殖器疣的重要依据。

Objective:Reflection confocal microscopy(RCM)is commonly used to assist in the diagnosis of skin diseases.RCM has been found to be useful in the diagnosis of genital warts.The characteristics of genital warts under RCM are not specific.This study aimed to face the challenge of diagnosing genital warts with RCM.Methods:We retrospectively studied 161 patients with clinical diagnosis of genital warts who underwent RCM examination.Histopathological examination was performed for 75 of these patients.The results of histological diagnosis and RCM diagnosis were compared and analyzed.Results:According to the RCM images,102 of the 161(63.35%)patients were diagnosed as genital warts.By comparison with histological results,the misdiagnosis rate of the 75 biopsy cases was 35.48%and the missed diagnosis rate was 20.45%.The diseases of misdiagnosis and missed diagnosis mainly included bowenoid papulosis,pseudocondylona of vulvae,squamous cell carcinoma in situ,molluscum contagiosum,and lichen planus.We further found that the RCM characteristics of genital warts conformed by histology were koilocytes,which mainly appeared in the granular layer or the spinous layer,larger than normal skin keratinocytes,and the cytoplasm with low refractive index.Conclusion:Due to the commonality of the microscopic characteristics of genital warts and related diseases,some cases are easy to be misdiagnosed or missed diagnosed.Diagnostic koilocytes could be an important basis for the diagnosis of genital warts.