阴道镜宫颈活检对宫颈癌前病变的诊断效能及漏诊因素分析

Analysis of Diagnostic Efficacy and Missed Diagnosis Factors of Colposcopy Cervical Biopsy in Cervical Precancerous Lesions

目的 研究阴道镜宫颈活检在宫颈癌前病变诊断中的效能以并分析漏诊发生原因。方法 前瞻性纳入因子宫颈癌筛查异常而转检阴道镜检查的患者318例为研究对象,在阴道镜下对每位患者实施子宫颈4个活检点的定位活检(包括病变或疑似病变区域的靶向活检与正常区域随机活检),以评估靶向与随机活检对宫颈癌前病变的诊断效能。结果 318例患者病理诊断CIN II+共173例(54.40%,173/318),阴道镜下靶向活检CIN Ⅱ+检出168例(97.11%,168/173);以阴道镜结果 G2为阈值的敏感度低于G1(分别为71.43%与97.11%);随机活检点能够增加靶向活检的检出率(P<0.05);1个活检点的检出率低于多个活检点(1、2、4、4个活检点诊断敏感度分别为80.35%、97.69%、100.0%、100.0%)。结论 阴道镜下宫颈活检对宫颈癌前病变具有较好诊断效能,活检时通过靶向活检与多点活检可实现增量效应,结合宫颈癌筛查与阴道镜诊断结果可获得更好诊断效能。

Objective To study the diagnostic efficacy and analyze the missed diagnosis factors of colposcopy cervical biopsy in cervical precancerous lesions.Methods A total of 318 patients who were transferred for colposcopy due to abnormal cervical cancer screening were prospectively enrolled as subjects.Localized biopsies of 4 biopsy sites of the cervix were performed for each patient under colposcope(including targeted biopsy and random biopsy in the lesion or suspected lesion area)in order to evaluate the diagnostic efficacy of targeted and random biopsy for cervical precancerous lesions.Results Among the 318 patients,173(54.40%,173/318)were pathologically diagnosed with CIN Ⅱ+,and 168(97.11%,166/173)were detected by colposcopy targeted biopsy with CIN II+.The sensitivity of colposcopy result with G2 as the threshold was lower than that with G1(71.43% and 97.11%respectively).Randomized biopsy sites can increase the detection rate of targeted biopsies(P<0.05).The detection rate of 1 biopsy site was lower than that of multiple biopsy sites(diagnostic sensitivity of 1,2,4 and 4 biopsy sites were 80.35%,97.69%,100.0%,100.0%,respectively).Conclusion Colposcopy cervical biopsy has good diagnostic efficacy for cervical precancerous lesions.Incremental effect can be achieved through targeted biopsy and multiple biopsies during biopsy,and better diagnostic efficacy can be obtained by combining the results of cervical cancer screening and colposcopy diagnosis.