子宫颈癌前病变极高风险者“即看即治”可行性探讨  

The feasibility of see-and-treat management on women at high risk of cervical precancer

作　　者：毕蕙[1] 贾芃[1] 颛佳 张岱[1,2] BI Hui;JIA Peng;ZHUAN Jia;ZHANG Dai(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院妇产科,100034 [2]沧州市人民医院妇科

出　　处：《中国妇产科临床杂志》2020年第6期563-566,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨子宫颈癌前病变极高风险者"即看即治"的可行性。方法回顾性分析北京大学第一医院于2017年1月至2018年6月因宫颈细胞学+人乳头瘤病毒(HPV)筛查异常转诊阴道镜,并同时进行多点定位活检并必要时行子宫颈管搔刮术(ECC)的1 671例患者的临床资料,以病理结果为诊断的金标准,评估极高风险者组织病理学诊断高级别鳞状上皮内及以上病变的风险。结果宫颈细胞学高级别异常、HPV16/18阳性者在阴道镜未见异常、低级别异常及高级别异常时HSIL+风险分别为60.0%(3/5)、69.7%(23/33)及93.2%(109/117);宫颈细胞学高级别异常、阴道镜为高级别异常者在HR-HPV阴性、HPV16/18阴性及HPV16/18阳性时HSIL+风险分别为67.6%(23/34)、90.0%(54/60)及93.2%(109/117);HPV16/18阳性、阴道镜为高级别异常者在细胞学阴性、低级别异常及高级别异常时HSIL+风险分别为51.1%(45/88)、63.8%(30/47)及93.2%(109/117)。结论在宫颈细胞学HSIL、高危型HPV阳性、阴道镜为高级别异常时,其HSIL+风险≥90%,建议直接行诊断性锥切术。Objective To evaluate the feasibility of see-and-treat management on women at high risk of cervical precancer. Methods We retrospectively collected the clinical records of 1671 women referred to colposcopy because of abnormal ‘co-test’ screening results and took multiple targeted biopsies with or without ECC(endocervical curettage) between January 2017 and June 2018 in Peking University First Hospital, and evaluated the risk of detecting histologically HSIL+ in women at high risk, using histology as ’golden standard’. Results In women with cytology HSIL and positive HPV16/18, histological HSIL+ was found in 60.0%(3/5), 69.7%(23/33) and 93.2%(109/117) of women with colposcopy impression of normal, LSIL and HSIL. In women with cytology HSIL and colposcopy impression of HSIL, histological HSIL+ was found in 67.6%(23/34), 90.0%(54/60), and 93.2%(109/117) of women with negative HR-HPV, negative HPV16/18 and positive HPV16/18. In women with positive HPV16/18 and colposcopy impression of HSIL, histological HSIL+ was found in 51.1%(45/88), 63.8%(30/47) and 93.2%(109/117) of women with cytology of cytology of normal, LSIL and HSIL. Conclusion Diagnostic conization could be suggested directly to patients with cytology of HSIL, positive HR-HPV and colposcopy impression of HSIL, the risk of HSIL+ was more than 90%.

关 键 词：子宫颈细胞学 人乳头瘤病毒 阴道镜 定位活检 子宫颈高级别鳞状上皮内病变 

分 类 号：R737.33[医药卫生—肿瘤]