宫颈随机活检在宫颈高级别病变诊断中的应用
摘要
目的观察宫颈随机活检在宫颈高级别病变诊断中的应用。方法 163例宫颈病变患者,阴道镜检查风险分层为宫颈高级别病变低风险组78例、中风险组63例、高风险组22例,均行阴道镜下宫颈定位活检、随机活检,取宫颈组织进行病理诊断,以病理诊断为金标准比较宫颈定位、随机活检结果的一致性,分析阴道镜下宫颈随机活检在宫颈高级别病变诊断中的作用。结果低风险组病理宫颈病变为≥宫颈上皮内瘤变(cervical intraepithelial neoplasm,CIN)Ⅱ者6例。宫颈定位活检中宫颈病变为≤CINⅠ、≥CINⅡ者分别为72、6例。宫颈随机活检中宫颈病变为≤CINⅠ、≥CINⅡ者分别为77、1例;宫颈定位活检中宫颈病变为≥CINⅡ的6例(7. 7%)患者中,1例(1. 3%)宫颈随机活检病理诊断为≥CINⅡ;定位活检和随机活检病理结果一致性为93. 6%(Kappa=0. 270,P=0. 000)。中风险组病理宫颈病变为≥CINⅡ者20例;宫颈定位活检中宫颈病变为≤CINⅠ、≥CINⅡ者分别为44、19例,宫颈随机活检中宫颈病变为≤CINⅠ、≥CINⅡ者分别为57、6例;宫颈随机活检中宫颈病变为≥CINⅡ的6例患者中,1例宫颈定位活检病理诊断为≤CINⅠ;定位活检和随机活检病理结果一致性为76. 2%(Kappa=0. 298,P=0. 003)。高风险组病理宫颈病变为≥CINⅡ者16例;宫颈定位活检中宫颈病变为≤CINⅠ、≥CINⅡ者分别为6、16例,宫颈随机活检中宫颈病变为≤CINⅠ、≥CINⅡ者分别为18、4例;宫颈随机活检中宫颈病变为≥CINⅡ的16例患者中,4例宫颈定位活检病理诊断为≥CINⅡ;定位活检和随机活检病理结果一致性为40. 9%(Kappa=0. 154,P=0. 176)。结论与宫颈定位活检比较,宫颈随机活检对宫颈高级别病变中、高风险患者的宫颈病变诊断准确率高。
引文
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[12]Van d MJ,Van Baars R,Rodriguez A,et al. The increased detection of cervical intraepithelial neoplasia when using a second biopsy at colposcopy[J]. Gynecol. Oncol,2014,135(2):201-207.
[2]Ferlay J,Shin H R,Bray F,et al. Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008[J]. Int J Cancer,2010,127(12):2893-2917.
[3]Pretorius RG,Belinson JL,Burchette RJ,et al. Regardless of Skill,Performing More Biopsies Increases the Sensitivity of Colposcopy[J]. J Low Genit Tract Dis,2011,15(3):180-188.
[4]Hu SY,Zhang WH,Li SM,et al. Pooled analysis on the necessity of random 4-quadrant cervical biopsies and endocervical curettage in women with positive screening but negative colposcopy[J].Medicine,2017,96(17):e6689.
[5]Wentzensen N,Schiffman M,Silver MI,et al. ASCCP Colposcopy Standards:Risk-Based Colposcopy Practice[J]. J Low Genit Tract Dis,2017,21(4):230-234.
[6] Wentzensen N,Massad LS,Mayeaux EJ,et al. Evidence-based consensus recommendations for colposcopy practice for cervical cancer prevention in the United States[J]. J Low Genit Tract Dis,2017,21(4):216-222.
[7]De Blasio BF,Neilson AR,Klemp M,et al. Modeling the impact of screening policy and screening compliance on incidence and mortality of cervical cancer in the post-HPV vaccination era[J]. J Public Health,2012,34(4):539-547.
[8]Wentzensen N,Walker J,Smith K,et al. A prospective study of risk-based colposcopy demonstrates improved detection of cervical precancers[J]. American Journal of Obstet Gynecol,2018,218(6):6041-6048.
[9]Vallapapan A,Chandeying N,Srijaipracharoen S,et al. The role of random cervical biopsies in addition to colposcopy-directed biopsies in detection of CIN2+[J]. J Obstet Gynaecol,2019,39(2):184-189.
[10]Stoler MH,Vichnin MD,Ferenczy A,et al. The accuracy of colposcopic biopsy:Analyses from the placebo arm of the Gardasil clinical trials[J]. Int J Cancer,2011,128(6):1354-1362.
[11]Silver MI,Andrews J,Cooper CK,et al. Risk of Cervical Intraepithelial Neoplasia 2 or Worse by Cytology,Human Papillomavirus16/18,and Colposcopy Impression[J]. Obstet. Gynecol,2018,132(3):725-735.
[12]Van d MJ,Van Baars R,Rodriguez A,et al. The increased detection of cervical intraepithelial neoplasia when using a second biopsy at colposcopy[J]. Gynecol. Oncol,2014,135(2):201-207.