446例阴道镜活检诊断为低级别宫颈上皮病变后行锥切术的回顾性分析

Retrospective analysis of 446 cases of conization after colposcopy biopsy diagnosed as low-grade cervical epithelial lesions

目的:通过分析阴道镜活检病理结果证实为低级别鳞状上皮内病变(LSIL)与诊断性锥切术后病理学结果的一致性,及术后病理升级的相关因素,旨在指导LSIL病例的规范诊治。方法:对2010年1月至2022年6月间因阴道镜下活检组织病理诊断为LSIL并接受切除手术的446名患者进行回顾性研究。结果:446名宫颈上皮内瘤变1级(CINⅠ)患者诊断性锥切术后病检结果提示:慢性宫颈炎221例、CINⅠ129例、宫颈上皮内瘤变Ⅱ/Ⅲ级(CINⅡ/Ⅲ)92例、宫颈原位腺癌(AIS)2例、鳞癌2例,其中年龄、主诉及高危型人乳头瘤病毒(HR-HPV)检测结果与术后病理升级无相关性,细胞学结果与术后病理升级密切相关。结论:阴道镜下的病理活检可以满足近80%的LSIL的诊断,但存在漏诊高级别鳞状上皮内病变(HSIL)及以上病变的风险。需综合考虑细胞学异常类型、HRHPV基因分型、临床症状等因素,进行个性化处理,适当放宽切除性手术的适应证。

Objective:To investigate the concordance between pathological findings of colposcopy biopsies confirmed as low-grade cervical epithelial lesion(LSIL)and pathological findings after diagnostic con-ization and factors associated with postoperative pathological escalation.Methods:This study was performed on 446 patients with LSIL due to colposcopy biopsy histopathology and underwent coniza-tion between January 2010 and June 2022.Results:Pathological findings after diagnostic conization in 446 patients with the cervical intraepithelial lesion(CIN)Ⅰsuggested 221 cases of chronic cervicitis,129 cases of CINⅠ,92 cases of CINⅡ/Ⅲ,2 cases of adenocarcinoma in situ(AIS),and 2 cases of squamous carcinoma.Age,chief complaint and high risk-humanpapilloma virus(HR-HPV)test re-sults were not statistically correlated with postoperative pathological escalation,while the thinprep cy-tology test was strongly correlated with postoperative pathological escalation.Conclusion:Colposco-py biopsy pathology can satisfy the diagnosis of nearly 80%LSIL,but there is a risk of missing le-sions of HSIL and above.Comprehensive consideration of screening results,individualized manage-ment,and appropriately broadening indications for diagnostic conization procedures are needed to re-duce postoperative pathologic escalation.In particular,timely cone biopsy is recommended for ASC-H/HSIL patients to improve the diagnosis of cervical cancer as well as precancerous cervical lesions.