阴道镜定位活检诊断宫颈上皮内瘤变的一致性及宫颈浸润癌漏诊的相关因素  

Consistency of colposcopy biopsy in the diagnosis of cervical intraepithelial neoplasia and related factors of missed diagnosis of invasive carcinoma of cervix

作　　者：曹敏华 杨如[1] 郑翠[1] 贾颖娜 CAO Minhua;YANG Ru;ZHENG Cui;JIA Yingna(Department of Gynaecology and Obstetrics,the Affiliated Suzhou Hospital of Nanjing Medical University(Suzhou Municipal Hospital),Suzhou 215000,Jiangsu,China)

机构地区：[1]南京医科大学附属苏州医院(苏州市立医院)妇产科,江苏苏州215000

出　　处：《中国性科学》2022年第10期98-102,共5页Chinese Journal of Human Sexuality

基　　金：苏州市“科教兴卫”青年科技项目(KJXW2017031)。

摘　　要：目的观察阴道镜定位活检诊断宫颈上皮内瘤变(CIN)的一致性,并分析宫颈浸润癌漏诊的影响因素。方法选取南京医科大学附属苏州医院2017年10月至2020年10月收治的106例高度疑似CIN的患者作为研究对象,均行阴道镜定位活检和手术治疗,以病理结果作为“金标准”,评估阴道镜定位活检诊断CIN的价值,并分析阴道镜定位活检诊断宫颈浸润癌漏诊的影响因素。结果106例高度疑似CIN的患者经病理确诊为CIN 64例,其中Ⅰ级18例、Ⅱ级30例、Ⅲ级16例;确诊为宫颈浸润癌42例。阴道镜定位活检诊断CIN与病理结果具有强一致性(Weighted Kappa系数=0.903)。病理确诊的42例宫颈浸润癌患者中,经阴道镜定位活检确诊34例,漏诊8例;经多项Logistic回归分析显示,高龄、宫颈病变面积<50%、图像质量较差、活检取样人资质获取时间<5年是阴道镜定位活检漏诊宫颈浸润癌的影响因素(OR>1,P<0.05)。结论阴道镜定位活检诊断CIN与病理结果具有强一致性,高龄、宫颈病变面积<50%、图像质量较差、活检取样人资质获取时间<5年是阴道镜定位活检漏诊宫颈浸润癌的影响因素。Objective To observe the consistency of colposcopy biopsy in the diagnosis of cervical intraepithelial neoplasia(CIN),and to analyze the influencing factors of missed diagnosis of invasive carcinoma of cervix.Methods 106 highly suspected CIN patients treated in the Affiliated Suzhou Hospital of Nan Jing Medical University from October 2017 to October 2020 were selected as the study subjects,all underwent colposcopy biopsy and surgical treatment.With the pathological results as the“gold standard”,the value of colposcopy biopsy in the diagnosis of CIN was evaluated,and the influencing factors of missed diagnosis of invasive carcinoma of cervix by colposcopy biopsy were analyzed.Results Among 106 highly suspected CIN patients,64 cases were confirmed as CIN by pathology,including 18 cases of gradeⅠ,30 cases of gradeⅡand 16 cases of gradeⅢ;42 cases were diagnosed as cervical invasive carcinoma.The diagnosis of CIN by colposcopic biopsy was consistent with pathological results(Weighted Kappa coefficient=0.903).Among the 42 cases of cervical invasive carcinoma confirmed by pathology,34 cases were confirmed by colposcopic localization biopsy,and 8 cases were missed.Multiple Logistic regression analysis showed that old age,cervical lesion area<50%,poor image quality,and acquisition time of biopsy sampler qualification<5 years were the influencing factors of missed diagnosis of cervical invasive carcinoma by colposcopic localization biopsy(OR>1,P<0.05).Conclusions The diagnosis of CIN by colposcopy biopsy is highly consistent with the pathological results,old age,cervical lesion area<50%,poor image quality and acquisition time of biopsy sampler qualification<5 years are the influencing factors of missed diagnosis of invasive carcinoma of cervix by colposcopy biopsy.

关 键 词：宫颈上皮内瘤变 宫颈浸润癌 阴道镜定位活检 漏诊 

分 类 号：R711[医药卫生—妇产科学]