阴道镜下宫颈管搔刮术的诊断研究

Diagnostic study of endocervical curettage under colposcope

目的探讨阴道镜下宫颈管搔刮术(ECC)的诊断价值。方法选取门诊机会性筛查的女性2095名,均行宫颈液基薄层细胞学检查(TCT)联合人乳头瘤病毒(HPV)筛查、阴道镜下多点活检及ECC取样,分析ECC的诊断价值。结果ECC总阳性率为6.8%(142/2095),ECC对高级别鳞状上皮内病变(HSIL)以上病变(HSIL+)的诊断敏感性为30.3%(95%CI:26.20~34.80),ECC对HSIL+的额外检出率为4.5%(21/468)。二元Logistic回归分析发现,年龄(OR=1.04,95%CI:1.02~1.06)、细胞学明显异常[不排除高级别鳞状上皮内病变的非典型鳞状细胞(ASC-H)/HSIL+](OR=16.65,95%CI:10.19~27.19)、转化区的可见性(OR=4.35,95%CI:2.71~6.97)和高危型人乳头瘤病毒(hrHPV)感染(OR=7.55,95%CI:2.72~20.98)是影响ECC对HSIL+检出率的危险因素。细胞学为非典型鳞状上皮细胞意义不明确(ASCUS)或低级别鳞状上皮内病变(LSIL)者,ECC对HSIL+的额外诊断价值极低,仅为0.6%(6/941)。在各年龄组中,细胞学为ASC-H/HSIL+、30岁以上且有HPV16/18感染者,ECC对HSIL+的诊断价值较高(11.0%~44.4%)。结论阴道镜下ECC在细胞学ASC-H/HSIL+,或年龄≥30岁且有HPV16/18感染的女性中具有较高的诊断价值,而对于细胞学轻微异常者,其额外诊断价值低。

Objective To explore the diagnostic value of endocervical curettage under colposcope(ECC).Methods 2095 women with opportunistic screening were selected and all underwent cervical liquid based thin layer cytology(TCT)combined with human papillomavirus(HPV)screening,colposcopy multi-point biopsy and ECC sampling to analyze the diagnostic value of ECC.Results The total positive rate of ECC was 6.8%(142/2095),the diagnostic sensitivity of high-grade squamous intraepithelial lesions(HSIL+)was 30.3%(95%CI:26.20~34.80),and the additional positive rate of ECC for HSIL+was 4.5%(21/468).Binary Logistic regression analysis showed that age(OR=1.04,95%CI:1.02~1.06),obvious cytological abnormality[atypical squamous cells:cannot exclude high-grade squamous intraepithelial lesion(ASC-H)/HSIL+](OR=16.65,95%CI:10.19~27.19),visibility of transformation region(OR=4.35,95%CI:2.71~6.97)and high-risk human papillomavirus(hrHPV)infection(OR=7.55,95%CI:2.72~20.98)were risk factors affecting the positive detection rate of HSIL+by ECC.For patients with atypical squamous epithelial cells of undertermined significance(ASCUS)or low-grade squamous intraepithelial lesions(LSIL),the additional diagnostic value of ECC for HSIL+was very low,only 0.6%(6/941).The diagnostic value of ECC for HSIL+was higher in patients with ASC-H/HSIL+cytology and over 30 years old with HPV16/18 infection(11.0%~44.4%).Conclusion Colposcopic ECC has a high diagnostic value in women with ASC-H/HSIL+cytology,or age≥30 years old and HPV16/18 infection,but it has a low additional diagnostic value in women with slight cytological abnormalities.