阴道镜初学者拟诊与病理诊断宫颈病变偏离原因探讨

发布时间：2018-02-24 23:02

本文关键词： 阴道镜宫颈癌筛查阴道镜拟诊过度阴道镜拟诊不足醋白上皮　出处：《实用妇产科杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的:评估阴道镜初学者阴道镜拟诊与病理诊断宫颈病变吻合情况,分析阴道镜拟诊不足和拟诊过度的原因。方法:回顾性分析2015年3~10月在北京大学第一医院由单一阴道镜初学者独立操作诊断的最初200例宫颈病变患者。对阴道镜拟诊与病理诊断吻合率、偏离率进行总结,并分析拟诊不足和拟诊过度的原因。结果:174例宫颈活检病理证实的患者中,拟诊吻合率59.2%,拟诊不足率18.4%,拟诊过度率22.4%。阴道镜诊断HSIL拟诊不足病例TCT正常率为78.6%,高于HSIL拟诊吻合病例18.1%,差异有统计学意义(P0.05)。HSIL拟诊不足病例14例患者的阴道镜图像中,在病理证实为HSIL的部位均有致密浓厚醋白上皮存在。HSIL拟诊不足病例绝经后妇女21.4%,高于HSIL拟诊吻合病例0%,差异有统计学意义(P0.05)。HSIL拟诊吻合病例取活检数目高于拟诊不足病例(中位数3.5 vs 2),差异有统计学意义(P0.05)。拟诊过度病例活检数目高于拟诊吻合病例(中位数3 vs 2),差异有统计学意义(P0.05)。结论:阴道镜拟诊宫颈病变时过度依赖TCT检查结果、对醋白上皮认识不足和对绝经后妇女容易发生拟诊不足,增加活检数目对于HSIL拟诊吻合率有帮助,但拟诊过度往往导致了活检数目的增加。
[Abstract]:Objective: to evaluate the anastomosis between colposcopy and pathological diagnosis of cervical lesions for beginners with colposcopy. The causes of insufficient and overdiagnosis of colposcopy were analyzed retrospectively. Methods: the initial 200 cases of cervical lesions diagnosed independently by beginners with single colposcopy from 2015 to October in Peking University first Hospital were analyzed retrospectively. The coincidence rate between diagnosis and pathological diagnosis, The deviation rate was summarized, and the causes of insufficient and overdiagnosis were analyzed. Results among 174 patients with pathologically confirmed cervical biopsy, The normal rate of TCT in colposcopic diagnosis of HSIL was 78.6, which was higher than that of HSIL. The difference was statistically significant in the colposcopy images of 14 patients with undiagnosed HSIL. There were dense and dense vinegar white epithelium in the pathologically confirmed sites of HSIL. There were 21.4in postmenopausal women with insufficient diagnosis of HSIL, which was higher than that in patients with HSIL anastomosis (0%). The difference was statistically significant (P 0.05). The number of biopsies obtained from the cases with HSIL-induced anastomosis was higher than that of undiagnosed cases. There was a significant difference between the two groups (median 3.5 vs 2n, P 0.05). The number of biopsies in over-diagnosed patients was higher than that in patients with anastomosis (median 3 vs 2). Conclusion: the colposcopy is too dependent on TCT in the diagnosis of cervical lesions, and there is no significant difference between the two groups (P > 0.05), conclusion: the pathological changes of cervix under colposcopy are excessively dependent on the results of TCT. Lack of understanding of vinegar white epithelium and lack of preclinical diagnosis in postmenopausal women. Increasing the number of biopsies is helpful to the rate of HSIL anastomosis, but overdiagnosis often leads to an increase in the number of biopsies.
【作者单位】：北京大学第一医院;
【分类号】：R737.33

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