阴道镜下ECC在CIN及宫颈癌诊断中的应用价值

Application value of endocervical curettage under colposcopy in the diagnosis of cervical intraepithelial neoplasia and cervical cancer

目的探讨阴道镜下宫颈管搔刮术(ECC)在宫颈上皮内瘤变(CIN)及宫颈癌诊断中的应用价值。方法选择2019年1月至2022年12月在上海建工医院行阴道镜检查的100例患者作为研究对象。所有患者均在阴道镜下行宫颈四象限多点活检和ECC,以病理诊断为金标准,对比分析阴道镜下ECC、阴道镜下多点活检与病理诊断的一致率,比较两种检测方式对CIN分级和宫颈癌的诊断符合率和漏诊率。结果阴道镜下ECC病理结果一致率为94.00%(kappa=0.915),多点活检病理结果一致率为78.00%(kappa=0.724),ECC比多点活检一致率提升16.00%;多点活检联合ECC在CINⅡ级、CINⅢ级诊断中的符合率分别为96.00%、91.18%,均高于多点活检的80.00%、67.65%,差异均有统计学意义(P<0.05);阴道镜下ECC在宫颈上皮内瘤变(CIN)Ⅱ级、CINⅢ级诊断中的漏诊率分别为4.00%、8.82%,均低于多点活检的20.00%、32.35%,差异均有统计学意义(P<0.05)。结论阴道镜下ECC在CIN及宫颈癌诊断中的应用价值较高,尤其是对于CINⅡ级和CINⅢ级病变的诊断具有重要意义,值得临床推广应用。

Objective To explore the application value of endocervical curettage(ECC)under colposcopy in the diagnosis of cervical intraepithelial neoplasia(CIN)and cervical cancer.Methods A total of 100 patients who un derwent colposcopy at Shanghai Construction Engineering Hospital from January 2019 to December 2022 were selected as the study subjects.All patients underwent cervical four quadrant multi-point biopsy and ECC under colposcopy,with pathological diagnosis as the gold standard.The consistency rates of ECC under colposcopy and multi-point biopsy un der colposcopy with pathological diagnosis were compared and analyzed,and the diagnostic accuracy and missed diagno sis rates of the two detection methods for CIN grading and cervical cancer were compared.Results The consistency rate of ECC pathological results under colposcopy was 94.00%(kappa=0.915),and the consistency rate of multi-point bi opsy pathological results was 78.00%(kappa=0.724).ECC increased by 16.00%compared to multi-point biopsy;The co incidence rates of multi-point biopsy combined with ECC in the diagnosis of CIN gradeⅡand CIN gradeⅢwere 96.00%and 91.18%,respectively,which were higher than 80.00%and 67.65%of multi-point biopsy(P<0.05).The missed diagnosis rates of ECC in cervical intraepithelial neoplasia CIN)gradeⅡand CIN gradeⅢunder colposcopy were 4.00%and 8.82%,respectively,which were significantly lower than 20.00%and 32.35%of multi-point biopsy(P<0.05).Conclusion The application value of ECC under colposcopy in the diagnosis of CIN and cervical cancer is high,especially in the diagnosis of CIN gradeⅡand CIN gradeⅢlesions,which is of great significance and worthy of clini cal promotion and application.