异常阴道镜检查图像特征对子宫颈上皮内瘤变2级及以上病变的诊断效能研究  

Study on the image characteristics of abnormal colposcopy and its diagnostic efficacy for cervical intraepithelial neoplasia grade 2 and above lesions

作　　者：茅娅男 吴敏霞 MAO Ya'nan;WU Minxia(Department of Obstetric and Gynecology,Affiliated Hospital of Nantong University,Jiangsu,Nantong 226000,China;Department of Gynecology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南通大学附属医院妇产科,江苏南通226000 [2]南京医科大学第一附属医院妇科,南京210029

出　　处：《中国妇产科临床杂志》2025年第2期125-128,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的依据2017年ASCCP阴道镜检查标准,分析异常阴道镜图像的特征并评估其对子宫颈上皮内瘤变(CIN)2及以上病变(CIN2+)的诊断价值及相关影响因素。方法选取2017年5月至2021年1月因子宫颈癌筛查异常于南京医科大学第一附属医院行阴道镜检查、发现有异常阴道镜图像并获取组织病理结果的1762例患者,回顾性分析异常阴道镜图像与组织病理学的关系,并比较不同年龄组和不同HPV型别中的各阴道镜图像发生及CIN2+检出风险。结果(1)组织学病理诊断为低级别异常、高级别异常和浸润性宫颈癌与异常阴道镜印象低级别、高级别、可疑癌的完全符合率比较,差异无统计学意义(73.51%,69.88%,62.96%;P>0.05)。阴道镜下CIN2+检出风险随印象级别升高而明显增加(27.46%,74.00%,100%;P<0.05)。(2)在≥50岁者中低级别印象的CIN2+检出率(34.88%)高于<50岁者(23.13%,P<0.05)。(3)在≥50岁者中薄醋白上皮、细点状血管的CIN2+检出率明显高于<50岁者(35.77%,23.80%;62.50%,21.52%;P<0.05)。(4)HPV 16阳性者更有可能呈现高级别阴道镜印象(57.10%,38.20%;P<0.05)。高级别印象在HPV16阳性者中CIN2+的检出率更高(79.66%,63.43%;P<0.05)。(5)厚醋白上皮及内部边界在HPV16阳性者中CIN2+的检出率较非HPV16阳性者高(76.61%,63.57%;90.63%,67.74%;P<0.05)。结论低级别阴道镜图像、尤其是薄醋白上皮和细点状血管中CIN2+的检出率在≥50岁者更高,该人群需重视此两种低级别图像的充分活检以防漏诊CIN2+。高级别阴道镜图像的发生不仅与HPV16型别密切相关,两者联合更是预测CIN2+的有效证据。Objective To analyze the characteristics of abnormal colposcopic images and evaluate the diagnostic value of abnormal colposcopic images for CIN2+and its related influencing factors by 2017 ASCCP colposcopy criteria.Methods A total of 1762 patients who underwent colposcopy in the First Affiliated Hospital of Nanjing Medical University from May 2017 to January 2021 due to abnormal cervical cancer screening and found abnormal colposcopy images accompanied by corresponding targeted biopsy and obtained pathological results were selected.The correlation between abnormal colposcopy images and histopathology was retrospectively analyzed and the occurrence of colposcopic images and the risk of CIN2+detection in different age groups and HPV genotypes were compared.Results(1)In the patients with histological diagnosis of LSIL,HSIL and cancer,the complete coincidence rate with abnormal colposcopic impression of low grade,high grade abnormality and suspected cancer were.No significantly different(73.51%,69.88%,62.96%;P>0.05).The proportions of CIN2+detected by colposcopy increased significantly with the increase of impression grade(27.46%,74.00%,100%;P<0.05).(2)The detection rate of CIN2+in the low grade impression of≥50 years old(34.88%)was higher than that of<50 years old(23.13%,P<0.05).(3)The detection rate of CIN2+in thin acetowhite epithelium and fine punctation in≥50 years old was significantly higher than that in<50 years old(35.77%,23.80%;62.50%,21.52%;P<0.05).(4)HPV16-positive patients were more likely to have a high-grade colposcopic impression(57.10%,38.20%;P<0.05).The positive rate of CIN2+was higher in HPV16-positive patients than in non-HPV16positive patients(79.66%,63.43%;P<0.05).(5)The detection rate of CIN2+in HPV16-positive patients with dense acetowhite epithelium and inner border was higher than that in non-HPV16-positive patients(76.61%,63.57%;90.63%,67.74%;P<0.05).Conclusions The detection rate of CIN2+in low-grade colposcopic images,especially thin acetowhite epithelium and fine punction is higher

关 键 词：阴道镜检查 图像特征 子宫颈上皮内瘤变 诊断效能 

分 类 号：R737.33[医药卫生—肿瘤]