阴道镜筛查细胞学阴性的光滑宫颈上皮内瘤变的临床意义  

Clinical significance of colposcopy on screening cervical intraepithelial neoplasia in cytological negative and smooth cervices

作　　者：史佃云[1] 陈赛英[1] 孙燕[1] 

机构地区：[1]解放军八一医院妇产科,南京210002

出　　处：《临床肿瘤学杂志》2013年第2期159-162,共4页Chinese Clinical Oncology

摘　　要：目的探讨阴道镜筛查常规妇科检查宫颈光滑、细胞学阴性病例宫颈上皮内瘤变(CIN)的临床意义。方法对门诊就诊或健康体检中妇科检查肉眼观察宫颈光滑、细胞学检查阴性的女性1050例进行阴道镜检查;对醋酸白色上皮和碘不着色异常征象及其他可疑病变进行活检组织病理检查。结果 (1)1050例中有458例进行了活检,另有56例同时取阴道镜下可疑病变部位和宫颈口息肉/息肉样赘生物部位进行活检,检出CIN 68例,其中属高危病变CINⅡ/CINⅢ11例;(2)1050例中有72例同时表现醋酸白色上皮和碘不着色双异常,其中64例活检证实为CIN,醋酸和碘双染色试验异常对CIN的阳性预测值88.9%,漏诊率为3.3%;(3)宫颈息肉或息肉样赘生物局部取材350例,仅检出1例CIN(0.3%);阴道镜下异常病变部位取材164例,检出CIN 67例(40.9%),其中CINⅡ/CINⅢ11例(6.7%);(4)对164例阴道镜下可疑病变病例年龄分布分析显示,醋酸白色上皮和碘不着色双异常在性活跃期年龄段分布频率较高,与CIN的年龄分布相一致,而单纯碘不着色呈现随年龄增大而出现频率增高的特点。结论阴道镜下检查异常,尤其是醋酸白色上皮和碘不着色双异常,对筛查宫颈癌前病变CIN有积极意义,即使在细胞学检查阴性的光滑宫颈也有一定的必要性。Objective To evaluate the clinical value of the video colposcopy in screening cervical intraepithelial neoplasia （CIN） in cytological negative and smooth cervices by optically gynecological examination. Methods A total of 1050 women, whose cervices showed smooth by optical examination and cytological negative, were examined with electronic colposcopy in gynecological clinic, and biopsy was taken when the double abnormality of aceto-white epithelium and iodine negative, and other abnormal images were shown. A restrospective analysis of these cases was performed. Results （1） Four hundred and fifty-eight of 1050 cases were ex- amined by biopsy, including 56 cases of abnormal tissue with cervical polyp or polypoid tumors. Among them, 68 cases of CIN were found, including 11 cases of CIN CINⅡ/CINⅢ11. （2） Seventy-two of 1050 cases showed the double-abnormality of aceto-white epithelium and iodine negative. Among them, 64 cases were CIN determined by biopsy. And the positive predictive value of the double-abnormali- ty of aceto-white epithelium and iodine negative under colposcopy was 88.9% , with a false negative rate of 3.3%. （ 3 ） Among 458 women who were examied by biopsy, only one of 350 samples from cervical polyp tissue was CIN（0. 3% ） , while 67 of 164 samples from the tissues with abnormal colposcopie images were found to be CIN（40. 9% ） , indicating the close relation between abnormal col- poseopie findings and CIN. （4） The results of age-distribution analysis showed that, in the 164 cases with abnormal featares under col- poscopy, the incidence of double abnormality of aceto-white epithelium and iodine negative was higher in the age of sexual activity, just the same as the age distribution feature of CIN ; while single abnormality of iodine negative appeared more in the age of over 50 years. Conclusion Abnormal features displayed by colposcopy, especially the double abnormality of aeeto-white epithelium and iodine nega- tive, has an important significance for the screening of c

关 键 词：癌前病变 宫颈上皮内瘤变(CIN) 阴道镜检查 筛查 

分 类 号：R737.33[医药卫生—肿瘤]