阴道镜下子宫颈多点活检及颈管内膜刮取术对高级别子宫颈病变的诊断价值  

Diagnostic value of multiply biopsies and endocervical curettage on cervical lesions

作　　者：张凌[1] 杜辉[2] 张薇[2] YangBin 王纯[2] JeromeLBelinson 吴瑞芳[2] 

机构地区：[1]广东省妇幼保健院妇科,广州510010 [2]北京大学深圳医院深圳女性重大疾病早期诊断技术重点实验室,518036 [3]DepartmentofAnatomicPathology,ClevelandClinicFoundation,Cleveland,Ohio44195,USA [4]WomenHealthInstitute,ClevelandClinicFoundationPreventionOncologyIn-ternational,Cleveland,Ohio44118,USA

出　　处：《中华妇产科杂志》2015年第4期263-267,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：深圳市科技计划国际合作项目（GJ200807240026A）

摘　　要：目的：评价阴道镜下子宫颈多点活检及颈管内膜刮取术（ECC）对高级别子宫颈病变[指子宫颈上皮内瘤变（CIN）Ⅱ及以上病变]的诊断价值。方法2009年4月-2010年4月进行的深圳子宫颈癌筛查项目Ⅱ（SHENCCASTⅡ）是以子宫颈液基细胞学检查联合HPV检测[包括HPV DNA分型和第2代杂交捕获（HC-Ⅱ）法]方法在10000例妇女中进行子宫颈癌筛查，对于上述筛查指标任一结果阳性（即子宫颈癌筛查阳性）者同时行阴道镜下子宫颈多点活检及ECC，对其活检组织（包括多点活检和ECC）进行病理检查。实施阴道镜检查并获得有效病理检查结果及保存有清晰阴道镜图像者共2558例，其中阴道镜下子宫颈4个象限均无异常（即阴道镜检查阴性）者1790例。对照其活检组织的病理诊断，分析子宫颈细胞学检查与HPV检测结果提示高级别子宫颈病变的作用，探讨多点活检与ECC对诊断高级别子宫颈病变的价值。结果2558例行阴道镜检查妇女中，阴道镜检查阴性者1790例（69.98%，1790/2558），其中经多点活检及ECC获取的组织行病理检查后诊断为高级别子宫颈病变者共40例（2.23%，40/1790）。阴道镜检查阴性的40例高级别子宫颈病变患者中，细胞学检查为高级别鳞状上皮内病变（HSIL）和不能除外高度病变的鳞状上皮细胞（ASC-H）者与高级别子宫颈病变的患病高风险有关（OR值分别为28.37、15.07，P值分别为0.000、0.001）；HPV16、52、58、31、33、18型阳性者与高级别子宫颈病变的患病高风险有关（OR=3.11，P=0.017）；HC-Ⅱ法检测HPV阳性者与高级别子宫颈病变的患病高风险有关（OR=3.58，P=0.025）。2558例行阴道镜检查妇女中，≥40岁与〈40岁者ECC阳性（ECC阳性指ECC获取的组织病理诊断为高级别子宫颈病变）率分别为40.7%（44/108）和19.2%（24/125），两者比较，差异有统计学意义（χ2=13.01，P=0.000）；≥40岁�Objective To investigate the value of multiply biopsies and endocervical curettage （ECC）on diagnosing cervical lesions. Methods For the detection of cervical lesions, Shenzhen cervical cancer screening trial Ⅱ（SHENCCAST Ⅱ） program combined methods of HPV screening with liquid-based cytology（LBC）, any positive indicators was then performed multiply biopsies and ECC under colopscopy. A total of 2 558 clear colposcopic images and pathological diagnoses were reviewed. To analyse the pathological results and primary screening results of the negative colopscopic images for discussing the value of multiply biopsies and ECC. Results Overall 2 558 women′s colposcopic images and sampling results were completed and validated. 69.98% （1 790/2 558） women had normal colposcopy appearances. Among them, 2.23%（40/1 790） were diagnosed as cervical intraepithelial neoplasiaⅡor worse （CINⅡ＋）. The odds ratio of high-grade squamous intraepithelial lesion（HSIL） was 28.37 （P=0.000） and atypical squamous cell cannot exclude HSIL（ASC-H）was 15.07 （P=0.001）. HPV types 16,52,58,31,33 and 18 were related to high-grade cervical lesion with the odds ratio of 3.11（P=0.017）. Hybrid captureⅡ（HC-Ⅱ）DNA test results shown that women with HPV positive were 3.58 times more risky than those of HPV negative, which was related to high-grade cervical lesion （P=0.025）. Among the 2 558 women, CINⅡ＋detective rate from ECC were 40.7%（44/108） in older group （≥40 years） were higher than that of 19.2%（24/125） in younger group（〈40 years;χ2=13.01, P=0.000）. CINⅡ＋detective rate from multiply biopsies were 90.7%（98/108）in older group（≥40 years）were higher than that of 88.8%（111/125）in younger group （〈40 years;χ2=0.24, P〈0.05）. The highest risky items of detecting CINⅡ＋were as follows：（1）HSIL or ASC-H;（2）HPV types 16,18,52 and 58 positive（either one）;（3）HC-ⅡHPV positive, at least 2 of the 3 items were included among 32 cases o

关 键 词：宫颈上皮内瘤样病变 阴道镜检查 活组织检查 刮除术 

分 类 号：R737.33[医药卫生—肿瘤]