摘要
目的通过比较LEEP术后病理检查和阴道镜宫颈活检对宫颈癌前病变诊断结果的差异,评价阴道镜宫颈活检诊断宫颈癌前病变的准确性。方法对315例行妇科检查的患者行阴道镜宫颈活检和LEEP手术以及术后病理组织检查。结果阴道镜下宫颈活检与LEEP术后组织病理诊断的总符合率为57.15%(180/315),诊断不足20.95%(66/315),诊断过度21.90%(69/315);CINⅠ级诊断符合率为76.67%(23/30),漏诊CINⅡ/CINⅢ级2例,无原位癌和微小浸润癌漏诊。CINⅡ/CINⅢ级(含原位癌)符合率为56.67%(63/111),漏诊浸润癌33例(33/111)。相关因素对比分析发现,阴道镜活检结果为高级别CIN和细胞学检查结果为HSIL及以上,是阴道镜宫颈活检浸润癌漏诊的危险因素(P<0.05)。结论阴道镜宫颈组织活检存在漏诊宫颈微小浸润癌的风险。阴道镜宫颈组织活检对象如果为高级别CIN患者,则应行LEEP术以达到进一步确诊或排除浸润癌的目的。
Objective To compare the difference between histopathology after LEEP and colposcopy cervical biopsy,and to evaluate the accuracy of diagnosing cervical intraepithelial neoplasia with colposcopy cervical biopsy.Methods 315 patients with cervical diseases were examined by colposcopy cervical biopsy and pathology after loop electrosurgicai excision procedure.Results Coincidence rate of colposcopic cervical biopsy and histopathology after LEEP was 57.15%（180/315）,under diagnosis rate was 20.95%（66/315） and over diagnosis rate was 21.90%（69/315）;Coincidence rate of CINI was 76.67%（23/30）,missed 2 cases of CINⅡ/CINⅢand there was no misdiagnosed carcinoma in situ and tiny invasive cancer.Coincidence rate of CINⅡ/ CINⅢ（including carcinoma in situ） was 56.67%（63/111）,missed 33 cases of invasive carcinoma（33/111）.High grade of CIN diagnosed by colposcopy and cytological examination≥HSIL were risk factors of missed diagnosis（P0.05）.Conclusion The accuracy of diagnosing cervical intraepithelial neoplasia with colposcopy cervical biopsy is not satisfying,there are risks of misdiagnosis tiny invasive cancer.Patients with high-grade CIN diagnosd by colposcopic cervical biopsy should receive LEEP to avoid missed diagnosis of cervical carcinoma.
出处
《实用癌症杂志》
2013年第3期269-271,281,共4页
The Practical Journal of Cancer
关键词
阴道镜
宫颈上皮内瘤变
宫颈癌
宫颈环形电切术
诊断
Colposcopy
Cervical intraepithelial neoplasia（CIN）
Cervical cancer
Cervical loop electrosurgical excision procedure
Diagnose
