阴道镜下宫颈活组织检测在宫颈癌筛查中的临床应用研究

Clinical Application of Cervical Biopsy under Colposcope in Cervical Cancer Screeing

目的探讨阴道镜下宫颈活组织检测在宫颈癌筛查中的应用价值。方法纳入2016年1月-2018年11月自愿在某院接受宫颈癌前病变和宫颈癌筛查的≥21岁的妇女33 027例。先行宫颈液基细胞学检测(TCT)和人类乳头瘤病毒(HPV)检查,结果显示TBS分级≥意义不明的非典型鳞状上皮细胞(ASCUS)者或HPV阳性者继续行阴道镜检查及阴道镜下宫颈活检。对于宫颈高级别上皮内病变者继续进行宫颈锥切术和切除标本的病理学检查。将阴道镜拟诊结果与阴道镜下活检病理诊断结果进行比较,再将阴道镜下活检病理诊断结果与宫颈锥切术后病理诊断结果进行比较,计算完全符合率。结果共计2823例妇女接受了阴道镜检查。阴道镜拟诊结果与阴道镜下活检病理诊断结果完全符合率为64. 86%(1831/2823),阴道镜拟诊的假阳性诊断率为20. 44%(577/2823),漏诊率为14. 70%(415/2823)。各分级间2种诊断方法的完全符合率有显著差异。有485例妇女接受了宫颈锥切术。阴道镜下活检病理诊断结果与宫颈锥切术后病理诊断结果完全符合率为71.55%(347/485),阴道镜下活检病理诊断的假阳性诊断率为24. 12%(117/485),漏诊率为4. 33%(21/485)。各分级间2种诊断方法的完全符合率有显著差异。结论在宫颈癌筛查过程中可先行TCT和HPV联合检查,必要时转阴道镜下宫颈活检。对高级别上皮内病变及以上者、部分低级别鳞状上皮内病变者应进一步行宫颈锥切术。

Objective To explore the application value of cervical biopsy under colposcope in cervical cancer screening.Methods A total of 33027 women equal or greater than 21 years old who volunteered for cervical precancerous lesions and cervical cancer screening in our hospital from January 2016 to November 2018 were included.The members received cervical liquid based cytology(TCT)and human papillomavirus(HPV)examination.The ones whose results showed TBS grade equal or greater than atypical squamous epithelial cells of unknown significance(ASCUS)or positive HPV continued to receive colposcopy and cervical biopsy under colposcopy.For patients with high-grade cervical intraepithelial lesions,the cervical conization and pathological examination of excised specimens were continued.Then,the results of colposcopy were compared with those of the pathological diagnosis under colposcopy,and the results of colposcopic biopsy and pathological diagnosis after cervical conization were compared,and the coincidence rate were calculated.Results Finally,2823 cases of women were underwent colposcopy examination.The coincidence rate between the results of vaginoscopy and biopsy under colposcopy was 64.86%(1831/2823),the overdiagnosis rate of vaginoscopy was 20.44%(577/2823),and the under diagnosis rate was 14.70%(415/2823).There were significant differences in the complete coincidence rate between the two diagnostic methods.485 cases of women received cervical conization.The coincidence rate of colposcopic biopsy and pathological diagnosis after colposcopy examination was 71.55%(347/485),the overdiagnosis rate of colposcopic biopsy was 24.12%(117/485)and the underdiagnosis rate was 4.33%(21/485).There were significant differences in the complete coincidence rate between the two diagnostic methods.Conclusions In the process of screening for cervical cancer,the TCT and HPV examination can be performed first,and combined with cervical biopsy under colposcopy,the cervical conization should be further performed for patients with high-grade or greater cervical intraepithelial lesions and partial low grade squamous intraepithelial lesion.