多点活检在隐匿性子宫颈上皮内瘤变Ⅱ级及以上病变诊断中的价值  

Value of multi-point biopsy in the diagnosis of occult cervical intraepithelial neoplasia above grade Ⅱ

作　　者：宋娟[1] 王莉[1] 张琼[1] 杨鸿[1] 蔡春华[1] SONG Juan;WANG Li;ZHANG Qiong;YANG Hong;CAI Chun-hua(Department of Gynecology,the Third People′s Hospital of Chengdu,Chengdu 610014,Sichuan,China)

机构地区：[1]成都市第三人民医院妇科,成都610014

出　　处：《东南国防医药》2021年第6期600-603,共4页Military Medical Journal of Southeast China

摘　　要：目的探讨多点活检在隐匿性子宫颈上皮内瘤变(CIN)Ⅱ级及以上病变诊断中的价值。方法选取2020年1月至2021年1月成都市第三人民医院行宫颈癌筛查,且经病理确诊为CINⅡ级及以上病变的103例患者的198个石蜡标本象限作为研究对象。所有研究对象均经“三明治”法重制为5张连续切片,使用基质辅助激光解吸电离飞行时间质谱法(MALDI-TOF-MS法)对白片的人乳头瘤病毒(HPV)分型进行检测,并使用×10显微镜测量病灶鳞状上皮厚度。在阴道镜指示下分别对标本中可见病灶进行活检,并通过子宫颈随机多点活检发现隐匿性病变。结果确诊的103例患者的198个石蜡标本象限中,发现隐匿性病变31例,占52个象限;可见病变72例,占146个象限。经MALDI-TOF-MS法检测,可见病变中HPV16型所占象限的比例为52.05%,高于隐匿性病变的42.31%(P<0.05)。可见病变中病灶>1个象限的病例占比为79.17%,高于隐匿性病变的48.39%(P<0.01),可见病变的病灶范围更大。可见病变的鳞状上皮厚度平均(159.38±12.98)μm,亦厚于隐匿性病变平均厚度(135.94±10.05)μm(P<0.01)。HPV16型阳性患者中病灶>1个象限的病例占比为84.31%,高于非HPV16型阳性患者的55.77%(P<0.01),HPV16型阳性患者的病灶范围更大。HPV16型阳性病例的鳞状上皮厚度亦厚于非HPV16型阳性病例(P<0.01)。结论非HPV16型阳性导致的CINⅡ级及以上病灶鳞状上皮相对较薄和病灶范围小可能是导致隐匿性CIN不易发现的主要原因。对于非HPV16型阳性感染的患者在阴道镜检查中同时行宫颈转化区域的病灶活检和多点随机活检,有助于提升隐匿性病灶的检查率,使患者获得早期干预。Objective To investigate the value of multi-point biopsy in the diagnosis of occult cervical intraepithelial neoplasia(CIN)above grade Ⅱ.Methods From January 2020 to January 2021,198 paraffin quadrants of 103 patients with CIN Ⅱ and/or above diagnosed by pathology who underwent cervical cancer screening in Chengdu Third People′s hospital were selected as the research objects.All the subjects were reconstituted into 5 serial sections by sandwich method.The HPV typing of white sections was detected by MALDI-TOF-MS method,and the thickness of squamous epithelium was measured by x 10 microscope.The visible lesions detected by biopsy under colposcopy and the occult lesions detected by cervical random multi-point biopsy were observed.Results Among the 198 quadrants of paraffin specimens of 103 patients,31 cases were found with occult lesions,accounting for 52 quadrants;72 cases were found with visible lesions,accounting for 146 quadrants.MALDI-TOF-MS showed that the proportion of HPV16 type in quadrant of lesions(52.05%)was higher than that of occult lesions(42.31%)(P<0.05).The proportion of visible lesions with more than one quadrant(79.17%)was higher than that of occult lesions(48.39%)(P<0.01).The thickness of squamous epithelium in visible lesions was(159.38±12.98)μm,which was thicker than that in occult lesions(135.94±10.05)μm(P<0.01).The proportion of HPV16 positive patients with more than one quadrant lesions(84.31%)was higher than that of non HPV16 positive patients(55.77%)(P<0.01).The thickness of squamous epithelium in HPV16 positive cases was also thicker than that in non HPV16 positive cases(P<0.01).Conclusion Non HPV16 positive CIN grade Ⅱ and above lesions with relatively thin squamous epithelium and small lesion size may be the main reason for the difficulty in the detection of occult CIN.It is suggested that for patients with non HPV positive infection,biopsy and multi-point random biopsy of cervical transformation area should be performed simultaneously in colposcopy,which is helpful to impr

关 键 词：阴道镜 宫颈上皮内瘤变 隐匿性病变 宫颈癌筛查 多点随机活检 

分 类 号：R713.4[医药卫生—妇产科学]