阴道镜下不同活检方法在高级别子宫颈上皮内病变检出中的作用

发布时间：2018-12-15 08:19

【摘要】：目的探讨阴道镜下不同活检方法在HSIL检出中的作用。方法对388例宫颈癌筛查异常的妇女行阴道镜检查,并在阴道镜指引下行四象限点活检+ECC,以病理诊断为金标准。结果阴道镜指引下在子宫颈最异常处的第一块活检检出77.1%(54/70)的HSIL,在病变第二异常处活检额外检出4.3%(3/70)的HSIL,在病变异常处的两块定位活检检出HSIL+的敏感性为81.4%,特异性为96.1%,与筛查异常级别(OR=4.257,95%CI:1.590~11.397,P=0.004)、阴道镜拟诊(OR=27.124,95%CI:12.221~60.199,P=0.000)具有相关性;随机活检额外检出18.6%(13/70)的HSIL,其中6例CIN2,7例CIN3;在筛查低级别异常者中额外检出HSIL 8例,占2.3%(8/344),其中5例CIN2,3例CIN3;在高级别异常者中额外检出HSIL 5例,占11.4%(4/44),其中1例CIN2,4例CIN3,与筛查异常级别(OR=6.833,95%CI:1.702~27.432,P=0.007)具有相关性,ECC无额外HSIL的检出。结论在子宫颈癌筛查异常妇女中,阴道镜下可疑病变部位行阴道镜指引下的2点或以上活检为HSIL检出的主要方法;对于阴道镜下未发现异常的妇女,尤其是对宫颈癌筛查高级别异常的妇女建议行随机活检。
[Abstract]:Objective to investigate the role of different biopsy methods under colposcopy in the detection of HSIL. Methods 388 women with abnormal cervical cancer screening were examined by colposcopy, and four quadrant biopsy (ECC,) was performed under the guidance of colposcopy. Results under the guidance of colposcopy, 77.1% (54 / 70) of HSIL, was detected in the first piece of biopsy in the most abnormal part of the cervix, and 4.3% (3 / 70) of HSIL, was detected in the second abnormal part of the lesion. The sensitivity and specificity of two locational biopsies for detecting HSIL in abnormal lesions were 81.4 and 96.1, respectively. Colposcopy (OR=27.124,95%CI:12.221~60.199,P=0.000) was correlated. Of the 18. 6% (13 / 70) of HSIL, detected by random biopsies, 6 cases of CIN2,7 were found to have HSIL in 8 (8 / 344) of the low grade abnormal screening cases (2. 3%), of which 5 were CIN2,3 cases of CIN3;. HSIL was detected in 5 cases (11.4%) in the patients with high grade abnormality, in which 1 case with CIN2,4 was correlated with OR=6.833,95%CI:1.702~27.432,P=0.007, but no extra HSIL was detected in ECC. Conclusion in women with abnormal cervical cancer screening, 2 or more biopsy under the guidance of colposcopy is the main method of HSIL detection. Random biopsies are recommended for women with no abnormalities under colposcopy, especially for women with high-grade abnormalities in cervical cancer screening.
【作者单位】：北京大学第一医院妇产科;
【分类号】：R737.33

【相似文献】