阴道镜下活检对诊断TCT异常者宫颈病变的临床价值  

Clinical value of biopsy under colposcope in diagnosis of cervical lesion among the cases with abnormal TCT results

作　　者：高巍[1] 卢丹[1] 郑萍[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇科,100026

出　　处：《中国妇幼保健》2011年第22期3501-3503,共3页Maternal and Child Health Care of China

摘　　要：目的:探讨阴道镜下定位活检对诊断TCT阳性者宫颈病变的临床价值。方法:对2 367例TCT阳性者均行电子阴道镜下定位活检,最终以组织学诊断为金标准,对结果进行回顾性分析、比较和总结。结果:CIN及以上病例与病理诊断的符合率,TCT和阴道镜分别为55.47%和83.83%,两者比较差异有统计学意义(P<0.01)。TCT与病理诊断的符合率分别为LSIL55.27%、HSIL58.80%、癌73.50%,TCT提示非典型细胞(包括ASC-US,ASC-H)而病理诊断CIN及以上病例的阳性率分别是9.17%和54.04%,二者比较差异有统计学意义(P<0.01)。阴道镜拟诊断与病理诊断的符合率分别是LSIL70.78%、HSIL71.28%、癌83.50%、漏诊率3.23%。TCT与阴道镜比较,对CIN的诊断组内无明显差异而组间有差异(P<0.05);TCT对癌的诊断组内有差异而组间无明显差异(P<0.05);阴道镜对癌的诊断组内组间均无明显差异。结论:对TCT阳性者而言,阴道镜下定位活检对宫颈病变的检出率及与病理诊断的符合率均优于单纯TCT筛查,诊断的准确性随着病变级别的升高而上升。对TCT提示非典型细胞尤其是ASC-H者应加以重视,可能潜在严重的宫颈病变。但是阴道镜也存在一定的漏诊率,因此二者联合应用可提高宫颈病变的诊断率,减少漏诊、误诊的发生。Objective：To explore the clinical value of location and biopsy under colposcope in diagnosis of cervical lesion among the cases with positive TCT results.Methods：2 367 cases with positive TCT results received location and biopsy under colposcope,histological diagnosis was gold standard,the results were analyzed retrospectively,compared and summarized.Results：The coincidence rates of TCT and colposcope with pathological diagnosis for the cases with CIN and above lesions were 55.47% and 83.83%,respectively,there was significant difference（P 0.01）.The coincidence rate of TCT and pathological diagnosis： LSIL 55.27%,HSIL 58.80%,cancer 73.50%.The positive rates of lesions indicated by TCT as atypical cells（including ASC-US,ASC-H） but diagnosed definitely as CIN and above lesions by pathological diagnosis were 9.17% and 54.04%,respectively,there was significant difference（P 0.01）.The coincidence rate of colposcope and pathological diagnosis： LSIL 70.78%,HSIL 71.28%,cancer 83.50%,the missed diagnosis rate was 3.23%.Compared with colposcope,there was no significant difference in CIN diagnosis made by TCT within groups but there was significant difference in CIN diagnosis made by TCT among different groups（P0.05）;while there was significant difference in cancer diagnosis made by TCT within groups but there was no significant difference in cancer diagnosis made by TCT among different groups（P0.05）;there was no significant difference in cancer diagnosis made by colposcope within groups and among different groups.Conclusion：For the cases with positive TCT results receiving location and biopsy under colposcope,the detection rate of cervical lesions and coinicdence rate of colposcope and pathological diagnosis are higher than those in cases receiving simple TCT,the accuracy of diagnosis increases with the aggravation of the disease.The cases with the cervical lesions indicated by TCT as atypical cells（especially ASC-H） should be paid more attention to,because potential and severe cervical les

关 键 词：液基薄层细胞学 阴道镜 活检 宫颈病变 

分 类 号：R711.74[医药卫生—妇产科学]