宫颈上皮内病变2级患者宫颈冷冻治疗效果:106例1年随访结果

Cryotherapy for Cervical Intraepithelial Lesion 2(CIN2):One Year Follow-up of 106 Patients

目的探讨宫颈上皮内病变2级(cervical intraepithelial lesion 2,CIN2)患者宫颈冷冻治疗1年的效果。方法纳入2018年1月~2020年12月106例因CIN2行宫颈冷冻治疗并随访1年的病例,治疗后6、12个月使用液基薄层细胞学检查(ThinPrep Cytologic Test,TCT)和人乳头瘤病毒(human papillomavirus,HPV)联合筛查随访,对其中任一结果异常者行阴道镜指导下宫颈多点活检及宫颈管搔刮,活检病理结果为高度鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)(CIN2)为病变持续,HSIL(CIN3)及以上为病变加重。结果随访中TCT及HPV均阴性48例(45.3%),TCT异常[非典型鳞状上皮,意义不明(atypical squamous cell,undetermined significant,ASC-US)及以上]且HPV阳性21例,TCT异常6例,HPV阳性31例。58例TCT或HPV任一阳性者行阴道镜指导下宫颈活检,病理诊断炎症3例,低度鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)45例,HSIL(CIN2)10例,无进展至CIN3及以上者。CIN2持续率9.4%(10/106)。随访中TCT异常对CIN2持续的阳性预测值为22.2%(6/27),HPV阳性对CIN2持续的阳性预测值为19.2%(10/52)。不同HPV持续型别中HPV16伴其他12种阳性的多重感染者CIN2持续率最高[50.0%(3/6)]。结论宫颈冷冻治疗对于CIN2是有效治疗手段,尤其有适应证的患者可以优先考虑。

Objective To investigate the results of one year follow in women with cervical intraepithelial lesion 2(CIN2)who were treated by cervical cryotherapy.Methods A total of 106 women who were diagnosed as having CIN2 from January 2018 to December 2020 and treated by cervical cryotherapy were enrolled in our study.All the patients finished one year follow-up by ThinPrep Cytologic Test(TCT)and human papillomavirus(HPV)co-test after 6 and 12 months.The patients with any abnormal results were given cervical multiple-point biopsy directed by colposcopy and endocervical curettage.The patient with histopathology result as high-grade squamous intraepithelial lesion(HSIL)(CIN2)was defined as“lesion persistence”,and HSIL(CIN3)or greater was“lesion progress”.Results There were 45.3%(48/106)of the patients having both TCT and HPV negative results in the follow-ups.There were 21 patients with both abnormal results,6 patients with abnormal TCT only and 31 patients with abnormal HPV only.A total of 58 women with abnormal TCT test results and/or positive HPV had accepted colposcopy directed biopsy and cervical curetege.There were 3 cases diagnosed as inflammatory,45 low-grade squamous intraepithelial lesion(LSIL)and 10 HSIL(CIN2).No CIN3 or greater case was found.The persistence risk of CIN2 was 9.4%(10/106).During follow-ups,the positive predictive value of TCT abnormality for CIN2 persistence risk was 22.2%(6/27),and the positive predictive value of HPV abnormality was 19.2%(10/52).Among different HPV persistence types,patients with both positive HPV16 and other positive 12 types had the highest lesion persistence risk[50.0%(3/6)].Conclusion Cervical cryotherapy is a useful treatment for women with CIN2 and preferred for the patient with indications.