宫颈癌筛查异常人群实施阴道镜下宫颈活检的准确性及漏诊因素分析  

Analysis of the Accuracy and Missed Diagnosis Factors of Cervical Biopsy Under Colposcopy in Patients with Abnormal Cervical Cancer Screening

作　　者：何林怡 龚晓雪 宋丹丹 杨红灵[1] HE Linyi;GONG Xiaoxue;SONG Dandan;YANG Hongling(The First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,Henan,China)

机构地区：[1]南阳医学高等专科学校第一附属医院,河南南阳473000

出　　处：《中国药物滥用防治杂志》2025年第1期38-40,54,共4页Chinese Journal of Drug Abuse Prevention and Treatment

基　　金：河南省医学科技攻关计划(联合共建)项目(编号:LHGJ20193712)。

摘　　要：目的:探讨宫颈癌筛查异常人群实施阴道镜下宫颈活检的准确性,并分析宫颈上皮内瘤变(CIN)、宫颈癌的漏诊影响因素。方法:选取2022年12月—2023年12月因宫颈癌筛查异常人群而转阴道镜检查的176例患者作为研究对象,根据是否发生宫颈癌将其分成两组(CIN组95例,宫颈癌组81例),均实施子宫颈定位活检(靶向活检与随机活检),评估靶向活检、随机活检在CIN、宫颈癌诊断中的诊断效能,并利用Logistic回归分析筛查各项病理学指标对CIN、宫颈癌漏诊的影响。结果:阴道镜下宫颈活检共检出HSIL患者95例,LEEP术后病理诊断检出HSIL患者77例(符合率:81.05%),漏诊宫颈癌8例(漏诊率:8.42%)。阴道镜下宫颈活检共检出宫颈癌患者68例,LEEP术后病理检出宫颈癌患者70例(符合率:86.42%),漏诊宫颈癌11例(漏诊率:13.58%)。经Logistic回归模型分析显示,阴道镜图像质量、宫颈病变面积、活检标本个数是影响宫颈癌阴道镜下宫颈活检的独立危险因素(OR=5.124、2.571、3.855,P<0.05)。结论:阴道镜下宫颈活检在宫颈癌筛查异常人群中诊断CIN的准确率略低于宫颈癌,两者均会发生一定程度的漏诊事件。阴道镜图像质量、宫颈病变面积、活检标本个数是影响宫颈癌患者阴道镜下宫颈活检漏诊的独立危险因素。Objective:To investigate the accuracy of cervical biopsy under colposcopy in patients with abnormal cervical cancer screening,and to analyze the influencing factors of missed diagnosis of cervical intraepithelial neoplasia(CIN)and cervical cancer.Methods:A total of 176 patients who underwent colposcopy due to abnormal cervical cancer screening from December 2022 to December 2023 were selected as the research objects.According to the occurrence of cervical cancer,they were divided into two groups(95 patients in CIN group and 81 patients in cervical cancer group).Cervical biopsy(targeted biopsy and random biopsy)was performed to evaluate the diagnostic efficacy of targeted biopsy and random biopsy in the diagnosis of CIN and cervical cancer.Logistic regression analysis was used to analyze the effect of various pathological indicators on missed diagnosis of CIN and cervical cancer.Results:A total of 95 patients with HSIL were detected by cervical biopsy under colposcopy,77 patients with HSIL were detected by pathological diagnosis after LEEP(coincidence rate:81.05%),and 8 patients with cervical cancer were missed(missed diagnosis rate:8.42%).A total of 68 patients with cervical cancer were detected by cervical biopsy under colposcopy,70 patients with cervical cancer were detected by pathology after LEEP(coincidence rate:86.42%),and 11 patients with cervical cancer were missed(missed diagnosis rate:13.58%).Logistic regression model analysis showed that colposcopy image quality,cervical lesion area and number of biopsy specimens were independent risk factors affecting cervical biopsy under colposcopy for cervical cancer(OR=5.124,2.571,3.855,P<0.05).Conclusion:The accuracy of colposcopic cervical biopsy in the diagnosis of CIN in the population with abnormal cervical cancer screening is slightly lower than that of cervical cancer,and both of them will have a certain degree of missed diagnosis.The image quality of colposcopy,the area of cervical lesions and the number of biopsy specimens are independent risk factors for

关 键 词：阴道镜下宫颈活检 宫颈上皮内瘤变 宫颈癌 准确性 漏诊 ROC 

分 类 号：R73[医药卫生—肿瘤]