阴道镜下活检诊断宫颈上皮内瘤样病变的临床价值及漏诊因素分析  

Clinical value of colposcopic biopsy in the diagnosis of cervical intraepithelial neoplasia and analysis of the factors of missed diagnosis

作　　者：高芳丹 

机构地区：[1]中国人民解放军第四六三医院妇产科,辽宁110042

出　　处：《社区医学杂志》2016年第6期22-24,共3页Journal Of Community Medicine

摘　　要：目的评估阴道镜下活检诊断宫颈上皮内瘤样病变（cervical inteaepithelial neoplasia,CIN）的临床价值,分析漏诊相关因素。方法回顾性分析2012年3月—2015年3月收治的经阴道镜下活检诊断为CIN的160例患者的临床资料,所有患者均在近期内接受宫颈锥切术治疗,以病理结果作为金标准,评估阴道镜下活检诊断CIN的准确性,分析漏诊相关因素。计数资料采用χ2检验,影响因素分析采用Logistics回归分析,P〈0.05为差异有统计学意义。结果 160例患者经术后病理证实为CINⅠ级46例,CINⅡ～Ⅲ级101例,宫颈浸润癌13例,阴道镜活检与病理诊断符合率为91.9%,其中漏诊宫颈浸润癌13例,漏诊率为8.1%。细胞学结果（OR=8.162,95%CI为3.162～16.987）、阴道镜图像质量（OR=4.364,95%CI为1.122～8.621）、活检标本数量（OR=5.214,95%CI为1.416～10.562）、宫颈病变面积（OR=4.416,95%CI为1.126～9.687）均为阴道镜下活检漏诊宫颈浸润癌的独立因素。结论阴道镜下活检对宫颈病变诊断有其直观性优势,但对宫颈上皮瘤样病变诊断尚存在缺陷,同时对宫颈癌漏诊率较高,而细胞学结果、阴道镜图像质量、活检标本数量及宫颈病变面积均是影响其诊断宫颈癌准确性的相关因素。Objective To explore the clinical value of biopsy under colposcopy in the diagnosis of cervical intraepithelial neoplasia（CIN）,analysis the related factors of misdiagnosis.Methods Retrospective analysis the clinical data of 160 cases CIN from March 2012 to March 2015,all the patients were accepted cervical cone cutting treatment in the near future.The pathological examination was the diagnostical golden standard,evaluate the accuracy of biopsy under colposcopy in the diagnosis of CIN,analysis the related factors of misdiagnosis.Count data was processed by chi square test,Logistic regression analysis was used for risk factors,P0.05 was considered statistically significant.Results 160 patients were confirmed by postoperative pathology for CIN gradeⅠ 46 cases,CIN grade Ⅱ～Ⅲ 101 cases,invasive carcinoma of cervix uteri 13 cases.Colposcopy biopsy and pathological diagnosis coincidence rate was 91.9%,13 cases of misdiagnosis and cervical invasive carcinoma,the missed diagnosis rate was 8.1%.Cytology results（OR=8.162,95%CI 3.162- 16.987）,vaginal mirror image quality（OR=4.364,95%CI 1.122- 8.621）,biopsy specimen number（OR=5.214,95%CI 1.416- 10.562）,cervical lesion area（OR=4.416,95%CI 1.126- 9.687） were the independent factors of cervical invasive cancer biopsy diagnosis under colposcopy.Conclusion Diagnostic biopsy under colposcopy for cervical lesions has its intuitive advantages,but for cervical epithelial tumor syndrome diagnosis has its drawbacks.Cytology results,vaginal mirror image quality,biopsy specimen number,cervical lesion area were the independent factors of cervical invasive cancer biopsy diagnosis under colposcopy.

关 键 词：宫颈上皮瘤样病变 阴道镜 活检 漏诊 

分 类 号：R711.7[医药卫生—妇产科学]