阴道镜指引下多点活检遗漏子宫颈浸润癌14例临床分析

发布时间：2018-12-29 14:13

【摘要】：目的通过分析阴道镜指引下多点活检(CDB)遗漏子宫颈浸润癌患者的资料,探讨阴道镜活检后患者的管理模式。方法 645例CDB病理诊断为宫颈上皮内瘤变(CIN)2及以上病变(CIN2+)患者行子宫颈锥切术,对比锥切术前后的病理结果及14例遗漏的子宫颈浸润癌患者的年龄、筛查结果、阴道镜诊断、病变范围及是否向颈管内延伸等临床资料。结果 CDB病理诊断CIN2+的敏感度为95.0%,特异度为46.2%,子宫颈锥切术前后CIN2/3病理诊断的一致性为71.4%(450/630),宫颈浸润癌遗漏率为2.2%(14/630)。14例遗漏子宫颈浸润癌患者的平均年龄为(43.4±8.7)岁,其中10例筛查结果为高级别病变,11例HPV高危亚型感染(10例为HPV16),12例阴道镜诊断为HSIL+,9例病变范围超过子宫颈面积的50%,13例CDB病理结果为CIN3,10例宫颈锥切术后病理结果提示切缘不净。结论阴道镜指引下多点活检是诊断CIN2/3的一种简单而有效的方法,但可遗漏少部分子宫颈浸润癌。对于病理诊断CIN2/3者建议行子宫颈锥切术进一步诊断及治疗。
[Abstract]:Objective to analyze the data of (CDB) omitting invasive carcinoma of cervix under colposcopic guidance and explore the management mode of patients after colposcopy biopsy. Methods 645 patients with cervical intraepithelial neoplasia (CIN2) diagnosed pathologically as cervical intraepithelial neoplasia (CIN2) were treated with cervical conization. The pathological results before and after conization and the age and screening results of 14 patients with missed invasive cervical carcinoma were compared. Colposcopy diagnosis, extent of lesion and whether to extend into the cervical canal and other clinical data. Results the sensitivity and specificity of CDB in the diagnosis of CIN2 were 95.0 and 46.2 respectively. The consistency of pathological diagnosis of CIN2/3 before and after cervical conization was 71.4% (450 / 630). The average age of 14 patients with invasive carcinoma of the cervix was (43.4 卤8.7) years old. The screening results were high grade lesions in 10 cases, and high risk subtype of HPV infection in 10 cases (10 cases HPV16), the rate of omission was 2.2% (14 / 630), and the average age of 14 cases was (43.4 卤8.7) years old. HSIL was diagnosed by colposcopy in 12 cases, and in 9 cases, the pathological results of CDB in 13 cases whose lesion area exceeded the area of cervix were 50% and 13 cases. The pathological results of CIN3,10 cases showed that the incisor margin was not clean after conical resection of cervix. Conclusion Multi-point biopsy guided by colposcopy is a simple and effective method for the diagnosis of CIN2/3, but a small number of invasive cervical carcinoma can be omitted. Further diagnosis and treatment of cervical conization are recommended for pathological diagnosis of CIN2/3.
【作者单位】：北京大学第一医院妇科;
【分类号】：R737.33

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