阴道镜下宫颈活检对HSIL和宫颈浸润癌的诊断价值及宫颈浸润癌漏诊的影响因素  

Value of Colposcopic Cervical Biopsy in Diagnosis of HSIL and Invasive Cervical Carcinoma and Influencing Factors of Missed Diagnosis

作　　者：石鑫[1] 宋风丽[1] 史伟[1] 郅玲玲 贺笑茜 于帅 马丽丽[1] 高万里[1] SHI Xin;SONG Fengli;SHI Wei;ZHI Lingling;HE Xiaoqian;YU Shuai;MA Lili;GAO Wanli(Department of Obstetrics and Gynecology,Beijing Daxing District People′s Hospital,Beijing 102600,China)

机构地区：[1]北京市大兴区人民医院妇产科,北京102600

出　　处：《医学综述》2021年第10期2035-2039,共5页Medical Recapitulate

基　　金：北京市卫生与健康科技成果和适宜技术推广项目(2018-TG-74)。

摘　　要：目的分析阴道镜下宫颈活检对高级别鳞状上皮内病变(HSIL)和宫颈浸润癌的诊断价值及浸润癌漏诊的影响因素。方法回顾性分析2010年1月至2019年12月北京市大兴区人民医院妇科收治的阴道镜下宫颈活检的469例HSIL和宫颈浸润癌患者的临床资料,以宫颈冷刀锥切术或宫颈环形电切术的术后病理结果为金标准,评价阴道镜下宫颈活检诊断HSIL和宫颈浸润癌的符合率;采用Logistic回归分析宫颈浸润癌漏诊的影响因素。结果经阴道镜下宫颈活检诊断HSIL的469例患者,经宫颈冷刀锥切术或宫颈环形电切术术后病理诊断HSIL者396例,符合率为84.43%。术后病理降级35例,病理升级38例。单因素分析显示,不同年龄、阴道镜检查、阴道分娩史、宫颈病变组织面积及有无合并人乳头瘤病毒(HPV) 16和(或) HPV18感染、宫颈管搔刮的漏诊率比较差异有统计学意义(P <0.05)。多因素Logistic回归分析结果显示,年龄> 55岁、阴道镜检查不充分、阴道分娩史、宫颈病变组织面积<1/2、合并HPV16和(或) HPV18感染、无宫颈管搔刮是阴道镜下宫颈活检漏诊宫颈浸润癌的影响因素(P <0.05)。结论阴道镜下子宫颈活检诊断HSIL及宫颈浸润癌符合率较高,但是也存在一定的漏诊情况,诊断准确性有待进一步提高,阴道镜医师应注意年龄> 55岁、阴道镜检查不充分、有阴道分娩史、宫颈病变组织面积<1/2、合并HPV16和(或) HPV18感染的患者,对其进行宫颈管搔刮,降低宫颈浸润癌的漏诊率。Objective To analyze the diagnostic value of cervical biopsy under colposcopy on high-level squamous intraepithelial lesions( HSIL) and invasive cervical cancer and the influencing factors of missed diagnosis of invasive carcinoma. Methods The clinical data of 469 patients with HSIL and cervical invasive cancer who underwent colposcopic cervical biopsy in the Department of Gynecology,Beijing Daxing District People’s Hospital from Jan. 2010 to Dec. 2019 were retrospectively analyzed. With the pathological results of cold knife conization or circular electrosurgical excision as the gold standard,the coincidence rate of colposcopic cervical biopsy in the diagnosis of HSIL and cervical invasive cancer was evaluated;the influencing factors of missed diagnosis of invasive cervical cancer was analyzed by Logistic regression analysis. Results 469 patients were diagnosed by cervical biopsy under colposcopy,and 396 cases were pathologically diagnosed by cold knife conization or circular electrosurgical operation,the coincidence rate was 84. 43%. 35 cases were degraded and38 cases were upgraded. The single factor analysis showed that there were significant differences in the rate of missed diagnosis among different ages,colposcopy,history of vaginal delivery,area of cervical lesion,presence of human papilloma virus( HPV)16 and/or HPV18 infection,and curettage of cervical canal( P < 0. 05). The results of multivariate Logistic regression analysis showed that age > 55 years old,inadequate colposcopy,vaginal delivery history,cervical lesions tissue area < 1/2,combined HPV16 and/or HPV18 infection,and without curettage of cervical canal were the factors that influenced the missed diagnosis of cervical invasive carcinoma by colposcopy( P < 0. 05). Conclusion The coincidence rate of cervical biopsy under colposcopy in the diagnosis of HSIL and cervical invasive cancer is high,but there are still some missed diagnosis,and the diagnostic accuracy needs to be further improved. Colposcopists should pay attention to the patients who

关 键 词：高级别鳞状上皮内病变 阴道镜 宫颈活检 宫颈浸润癌 漏诊 影响因素 

分 类 号：R711.74[医药卫生—妇产科学]