宫颈锥切同时宫颈管诊刮诊断宫颈病变的价值评估  

Value evaluation of endocervical curettage with conization for diagnosing cervical lesions

作　　者：赵琳[1] 孔宪超[1] 王宇[1] 李佩玲[1] ZHAO Lin;KONG Xian-chao;WANG Yu;LI Pei-ling(Department of Gynaecology and Obstetrics,The Second Affiliated Hospital of Harbin Medical U niversity,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属第二医院妇产科,黑龙江哈尔滨150081

出　　处：《哈尔滨医科大学学报》2018年第4期364-367,共4页Journal of Harbin Medical University

摘　　要：目的证实宫颈锥切同时宫颈管诊刮(endocervical curettage,ECC)诊断宫颈病变的准确性。方法回顾性分析2012年1月到2016年12月在哈尔滨医科大学附属第二医院就诊,可疑宫颈瘤变并接受了宫颈锥切的514例患者的就诊记录。为了确定ECC评估宫颈病变的效力,把ECC与宫颈锥切分别获得的标本的组织病理学结果进行比较。锥切后继续接受子宫切除的患者中,把子宫上的残余宫颈标本与ECC获得的样本做比较。结果宫颈锥切同时ECC的患者占58. 9%。ECC获得的阳性结果只占7. 9%,阴性结果占67. 3%,还有4. 8%不符合诊断。根据ECC结果,没有患者被诊断为更高级别的病变。ECC在预测被锥切标本确诊的残余宫颈病变的敏感度为25%,特异度为94. 2%,阳性预测值为55%(κ=0. 238; P <0. 001)。ECC样本在预测被切除子宫的残余宫颈病变的敏感度为42. 9%,特异度为83. 9%,阳性预测值为54. 5%(κ=0. 284; P=0. 053)。结论宫颈锥切术同时ECC在评估宫颈病变上优势有限。临床医生对于鳞状上皮病变的患者可以考虑省略常规的ECC,对于腺细胞异常的患者可尝试ECC。Objective To verify the accuracy of endocervical curettage（ECC） with conization in diagnosis of cervical lesions. Methods The records of 514 patients with suspected neoplastic cervical lesions who underwent conization at the Second Affiliated Hospital of Harbin Medical University from January 2012 to December 2016 were analyzed retrospectively. To validate the effectiveness of ECC for evaluating endocervical lesions,histopathologic findings from ECC samples were compared with those from endocervical specimens obtained by conization. In patients who subsequently underwent hysterectomy,specimens of residual endocervical stump lesions were compared with the specimens obtained by ECC. Results ECC was performed in58. 9% of patients who underwent conization. Positive findings were only found in 7. 9%,while negative findings were found in 67. 3% of ECC samples; however,24. 8% of the samples were inadequate for diagnosis. None of the patients had an upgraded diagnosis according toECC results. The sensitivity of ECC in predicting endocervical stump lesions that were identified by conization specimens was 25. 0%,the specificity was 94. 2% and the positive predictive value was 55. 0%（κ = 0. 238; P 〈0. 001）. ECC samples yielded a sensitivity of42. 9%,a specificity of 83. 9%,and positive predictive value of 54. 5%（κ = 0. 284; P =0. 053） in predicting residual endocervical lesions in the uterus. Conclusion As it offers low sensitivity and positive predictive value,ECC at the time of conization is of limited benefit for evaluating endocervical lesions. Clinicians may consider omitting conventional ECC in patients with squamous epitheliopathy,and may try ECC in patients with glandular abnormalities.

关 键 词：宫颈上皮内瘤变 宫颈锥切术 宫颈管诊刮术 子宫切除术 

分 类 号：R737.33[医药卫生—肿瘤]