阴道镜联合TCT诊断宫颈上皮内瘤变效能及漏诊因素分析

Analysis of the efficacy and the related factors of missed diagnosis of colposcopy biopsy combined with thinprep cytology test for diagnosing cervical intraepithelial neoplasia

目的:探讨阴道镜检查与宫颈脱落细胞学(TCT)检测联合筛查宫颈上皮内瘤变(CIN)效能及漏诊因素分析。方法:回顾性收集2019年1月-2022年5月在本院妇科行手术治疗的89例患者临床资料,均行阴道镜及宫颈脱落细胞学薄层液基细胞学检查(TCT)检查,以术后病理诊断为金标准,统计阴道镜、TCT联合检测CIN效能;根据联合检测是否检出CIN将患者分为漏诊组(n=10)及诊出组(n=79),分析引起CIN漏诊的危险因素。结果:病理结果显示89例中,检出CIN阳性71例(79.8%)、阴性18例(20.2%),阴道镜活检检出阳性57例(64.0%),TCT检测阳性59例(66.3%),阴道镜联合TCT检出阳性64例(71.9%);通过受术者工作特征曲线分析,阴道镜联合TCT筛查CIN的敏感度为86.7%,特异度为80.5%;多因素分析显示,宫颈病变面积<1/2、活检标本数为1个、阴道镜图像模糊是CIN漏诊的危险因素。结论:阴道镜联合TCT检测可提高筛查CIN效率,同时改善阴道镜检测查图像质量,提高活检标本数是降低筛查CIN漏诊率的关键。

Objective:To investigate the diagnostic efficacy of colposcopy biopsy combined with thinprep cytology test(TCT)for diagnosing cervical intraepithelial neoplasia(CIN),and to analyze the related factors of the missed diagnosis of CIN.Methods:The clinical data of 89 patients who had been surgical treatment in department of gynecology from January 2019 to May 2022 were collected retrospectively.These patients had accepted colposcopy biopsy combined with TCT.The postoperative pathological result of the patients were as the gold standard for diagnosing their CIN,and the efficacies of the colposcopy biopsy,TCT,and the combined colposcopy biopsy and TCT of the patients for diagnosing their CIN were statistical analysis.The patients were divided in two groups according to the results of the combined colposcopy biopsy and TCT,including 10 patients with missed diagnosis of CIN in group A and 79 patients without missed diagnosis of CIN in group B.The risk factors of missed diagnosis of CIN were analyzed.Results:The pathological results showed that there were 71(79.8%)cases with positive CIN and 18(20.2%)cases with negative CIN.The colposcopy biopsy results showed that there were 57(64.0%)cases with positive CIN and the TCT results showed that there were 59(66.3%)cases with positive CIN.The colposcopy biopsy combined with TCT results showed that there were 64(71.9%)cases with positive CIN.The sensitivity and the specificity of colposcopy biopsy combined with TCT of the patients for screening their CIN were 86.7% and 80.5%.Multivariate analysis showed that the cervical lesion area<1/2 in colposcopy examination,only one colposcopy biopsy specimen,and the blurred colposcopic images of the patients were the risk factors for their missed diagnosis of CIN.Conclusion:The colposcopy biopsy combined with TCT of the patients for screening their CIN can increase the efficacy.The key to reduce the rate of missed diagnosis of CIN includes the improvement the colposcopic images quality and increase of the number of biopsy specimens in clinical application.