阴道镜活检对宫颈低级别鳞状上皮内病变(CIN1)的诊断分析  

Analysis of Colposcopy Biopsy Pathology in the Diagnosis of Cervical Low-grade Squamous Intraepithelial Lesions( CIN1)

作　　者：陈燕[1] 江维[1] 曾四元[1] 梁美蓉[1] 涂澜涛 祝慧婷 刘程程[1] 

机构地区：[1]江西省妇幼保健院,332209

出　　处：《实用癌症杂志》2016年第11期1818-1821,1830,共5页The Practical Journal of Cancer

摘　　要：目的评价阴道镜下宫颈活检诊断低级别鳞状上皮内病变（CIN1）的准确性,探讨CIN1术后（冷刀锥切或LEEP术）病理升级的相关因素。方法对946例宫颈低级别鳞状上皮内病变（CIN1）的患者施以宫颈环形电切术（LEEP）或锥切术,比较术前术后组织病理学诊断的符合率。结果手术前后CIN1的符合率88.47%（837/946）,CIN1中宫颈高级别鳞状上皮内病变（CIN2及以上）病理升级率11.52%（109/946）。单因素卡方检验分析显示,阴道镜检查前宫颈细胞学ASC-US/HSIL（χ~2=25.639,P〈0.001）、HR-HPV-DNA阳性（χ~2=9.500,P=0.001）、绝经（χ~2=33.613,P〈0.001）、颈管内膜活检阳性（χ~2=11.329,P〈0.001）、阴道镜检查满意状况（χ~2=80.858,P〈0.001）,是阴道镜下活检诊断宫颈低级别鳞状上皮内病变（CIN1）患者术后病理升级的影响因素。多因素Logistic回归分析显示,宫颈细胞学ASC-US/HSIL（OR=3.632,P〈0.001）、阴道镜检查满意状况（OR=9.365,P〈0.001）、绝经（OR=5.024,P〈0.001）、颈管内膜活检阳性（OR=2.183,P=0.049）均为病理升级为宫颈高级别鳞状上皮内病变（CIN2及以上病变,简称CIN2＋）的独立高危因素。结论阴道镜下活检诊断宫颈低级别鳞状上皮内病变（CIN1）存在宫颈高级别鳞状上皮内病变（CIN2＋）的漏诊。阴道镜检查满意状况、宫颈细胞学ASC-US及以上病变以及绝经、颈管内膜活检阳性等是个体化处理中需考虑的问题。Objective To evaluate the accuracy of CIN1 diagnosed by colposcopically directed biopsy,and to discuss the factors of postoperative pathological upgrading of CIN1.Methods 946 cases of CIN1 received loop electrosurgicall excision procedure（ LEEP） or cold knife conization were selected.Pathological diagnosis coincidence before and after surgery were compared.Results Before and after surgery,837cases（ 88.47%） were consistent and 109 cases（ 11.52%） were postoperative pathological upgraded.Univariate analysis showed that patients with poor cervical cytology（ ASCU-S / HSIL） before colposcopy（ χ~2= 25.639,P 0.001）,HR HPV-DNA（ χ~2= 9.500,P = 0.001）,menopause（ χ~2= 33.613,P 0.001）,cervical endometrial biopsy（ χ~2=11.329,P 0.001） and unsatisfactory colposcopy（ χ~2= 80.858,P 0.001） were risk factors of CIN1 postoperative pathological upgrading by colposcopy biopsy pathology.Multivariate logistic analysis showed that cervical cytology（ ASCU-S / HSIL）（ OR =3.632,P 0.001）,unsatisfactory.colposcopy（ OR = 9.365,P 0.001）,menopause（ OR = 5.024,P 0.001）,cervical endometrial biopsy（ OR = 2.183,P = 0.049） were independent risk factors of CIN1 postoperative pathological upgrading by colposcopy biopsy pathology.Conclusion There is missed diagnosis of CIN2 ＋ in the diagnosis of CIN1 colposcopy biopsy.Satisfactory of colposcopy,menopause,cervical endometrial biopsy doses should be considered in the individualized treatment.

关 键 词：宫颈上皮内瘤变 阴道镜 诊断 宫颈活检 

分 类 号：R737.33[医药卫生—肿瘤]