转化区类型在评估阴道镜下未见宫颈病变者随机活检中的价值

Value of transformation zone type in the evaluation of random biopsy among patients without visible lesions under colposcopy

目的·探讨宫颈转化区类型在评估阴道镜下未见病变者是否采用随机活检诊断宫颈高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)中的价值。方法·选取因人乳头瘤状病毒(human papillomavirus,HPV)高危亚型感染或液基薄层细胞学检测(thinprep cytologic test,TCT)结果异常而行阴道镜检查且未见病变患者517例,明确其宫颈转化区类型,并行宫颈随机活检,评估Ⅰ、Ⅱ、Ⅲ型宫颈转化区对诊断宫颈HSIL的价值。结果·阴道镜下未见病变者517例,其中Ⅲ型转化区396例,随机活检HSIL检出率为3.8%(15/396);Ⅰ、Ⅱ型转化区121例,HSIL的检出率为8.3%(10/121)。与Ⅲ型转化区相比,Ⅰ、Ⅱ型转化区HSIL的检出率显著升高(P=0.000)。Logistics回归结果提示,TCT结果异常和转化区类型为Ⅰ、Ⅱ型是阴道镜下未见病变者检出HSIL的危险因素。结论·对于阴道镜下未见病变但转化区为Ⅰ、Ⅱ型及TCT异常的女性,随机多点活检可提升其宫颈HSIL的检出率。

Objective·To explore the value of cervical transformation zone(TZ)type in assessing whether a random biopsy should be used to diagnose high-grade squamous intraepithelial lesion(HSIL)among patients without visible lesions under colposcopy.Methods·A total of 517 patients who underwent colposcopy(without visible lesions)due to high risk subtype infection of human papillomavirus(HPV)or thinprep cytologic test(TCT)abnormality were enrolled.TZ types were identified,random biopsies were performed,and the value of TZ typeⅠ,ⅡandⅢin the diagnosis of HSIL was evaluated.Results·There were 517 cases without visible lesions under colposcopy.Three hundred and ninety-six of them were TZ typeⅢ,and the detection rate of HSIL was 3.8%(15/396)by random biopsy,while one hundred and twenty one of them were TZ typeⅠandⅡ,and the detection rate of HSIL was 8.3%(10/121).Compared with the TZ typeⅢ,the detection rate of HSIL in the TZ typeⅠandⅡwas significantly increased(P=0.000).Logistic regression showed that TCT abnormality,TZ typeⅠandⅡwere the risk factors for HSIL detection in patients without visible lesions under colposcopy.Conclusion·Random multipoint biopsy can significantly increase detection rate of cervical HSIL when no visible lesion is visualized under colposcopy,particularly in women with abnormal TCT results or TZ typeⅠandⅡ.