阴道镜下宫颈活检诊断CIN1中漏诊CIN2及以上病变的分析  

Analysis of missed CIN2^+ in CIN1diagnosed by colposcopically directed biopsy

作　　者：钱敏[1] 尤志学[2] 姚芳芳[1] 彭晶晶[1] 邢燕[2] 周斌兵[2] 

机构地区：[1]南京医科大学第一临床医学院,210029 [2]南京医科大学第一附属医院妇科

出　　处：《中国妇产科临床杂志》2013年第5期403-405,共3页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的评价阴道镜下活检诊断CIN1的准确性,探讨漏诊CIN2及以上病变(简称CIN2+)的因素。方法对109例阴道镜下活检诊断CIN1的患者施以宫颈环形电切术(LEEP),对照比较术前术后组织病理学诊断的符合率,并回顾性分析术前各因素与漏诊CIN2+的相关性。结果 LEEP前后CIN1的符合率52.29%(57/109),CIN1中CIN2+漏诊率47.71%(52/109)。宫颈细胞学ASC-H/HSIL、阴道镜检查Ⅲ型转化区、年龄>40岁、HR-HPV DNA负荷量≥100pg/ml均为漏诊CIN2+的独立高危因素(相对危险度分别为5.24、5.08、3.16、3.13)。结论阴道镜下活检诊断CIN1存在CIN2+的漏诊。先前细胞学的严重程度是目前诊治规范中选择随访或干预的依据,但转化区类型、年龄、病毒负荷量等也是个体化处理中需考虑的问题。Objective To evaluate the accuracy of CIN1diagnosed by colposcopically directed biopsy and to discuss the factors of missed diagnosis of CIN2＋.Methods The 109cases who were diagnosed as CIN1by colposcopically directed biopsy received loop electrosurgical excision procedure（LEEP）.The coincidence of histopathologic diagnosis between colposcopically directed biopsy and LEEP was evaluated.The factors of missed diagnosis of CIN2＋were analyzed retrospectively.Results Among the 109CIN1cases,57cases（52.29%）were consistent and 52cases（47.71%）were missed diagnosis of CIN2＋.The risk factors of missed CIN2＋in CIN1diagnosed by colposcopically directed biopsy were cervical cytology（ASCH/HSIL）,unsatisfactory colposcopy,the ages of patients（40years old）,and HR-HPV DNA loading doses（≥100pg/ml）（OR：5.24,5.08,3.16and 3.13respectively）.Conclusions There was missed diagnosis of CIN2＋in CIN1.The severity of the previous cytology is the basis of follow-up or intervention.Unsatisfactory or satisfactory colposcopy,the ages of patients and HR-HPV DNA loading doses should also be considered in the individualized treatment.

关 键 词：宫颈上皮内瘤变 阴道镜 宫颈环形电切术 活检 

分 类 号：R737.33[医药卫生—肿瘤]