CAJ | 학술논문

目的评价阴道镜下宫颈活检诊断为宫颈上皮内瘤变(CIN1)的准确性,评估阴道镜下宫颈活检诊断为CIN1中漏诊CIN2+的相关因素.方法对274例阴道镜下宫颈活检诊断为CIN1且无法按计划随访的患者实施宫颈电环切术(LEEP),并对术前各项流行病学指标、宫颈细胞学、高危型人乳头瘤病毒杂交捕获Ⅱ代检测、阴道镜检查结果、病理结果等进行回顾性分析,评价上述因素与漏诊CIN2+的相关性.结果 274例中漏诊CIN2+85例,漏诊率31.0%.单因素分析显示阴道镜检查前宫颈细胞学结果、阴道镜检查满意状况和宫颈分泌物高危型HPV检测结果阳性是阴道镜下活检诊断CIN1患者漏诊CIN2+的影响因素,多因素分析发现阴道镜检查前宫颈细胞学结果和阴道镜检查满意状况是阴道镜下活检诊断CIN1患者漏诊CIN2+的独立影响因素,其相对危险度分别是4.67和2.06.结论阴道镜下宫颈活检诊断CIN1漏诊CIN2+概率较高,阴道镜检查前宫颈细胞学结果和阴道镜检查满意状况是阴道镜下活检诊断CIN1患者漏诊CIN2+的独立影响因素.
목적 평개음도경하궁경활검진단위궁경상피내류변(CIN1)적준학성,평고음도경하궁경활검진단위CIN1중루진CIN2+적상관인소.방법 대274례음도경하궁경활검진단위CIN1차무법안계화수방적환자실시궁경전배절술(LEEP),병대술전각항류행병학지표、궁경세포학、고위형인유두류병독잡교포획Ⅱ대검측、음도경검사결과 、병리결과 등진행회고성분석,평개상술인소여루진CIN2+적상관성.결과 274례중루진CIN2+85례,루진솔31.0%.단인소분석현시음도경검사전궁경세포학결과 、음도경검사만의상황화궁경분비물고위형HPV검측결과 양성시음도경하활검진단CIN1환자루진CIN2+적영향인소,다인소분석발현음도경검사전궁경세포학결과 화음도경검사만의상황시음도경하활검진단CIN1환자루진CIN2+적독립영향인소,기상대위험도분별시4.67화2.06.결론 음도경하궁경활검진단CIN1루진CIN2+개솔교고,음도경검사전궁경세포학결과 화음도경검사만의상황시음도경하활검진단CIN1환자루진CIN2+적독립영향인소.
Objective To assess the accuracy of colposcopy-assisted biopsy for the diagnosis of cervical intraepithelial neoplasia Ⅰ (CIN1 and to reappraise the correlative factors of missed CIN2 + in lowgrade SIL( squamous intraepithelial lesion) pathologically diagnosed by colposcopy-assisted biopsy. Methods A total of 274 women with CIN1 diagnosed by colposcopy-assisted biopsy and missing scheduled follow-up thus elected to undergo loop electrosurgical excisional procedure (LEEP). Epidemiological data and cervical cytology, high risk human papillomavirus (HR-HPV) detection and colposcopy with directed biopsy and endocervical curettage if necessary prior to LEEP were reviewed and correlation of missed CIN2+ and all the above factors analyzed. Results Among these patients, 85 cases (31.0%) of CIN2+ were detected. Univariate analysis showed that poor cervical cytology before colposcopy, unsatisfactory colposcopy and positive HR-HPV detection were risk factors of missed CIN2+ in low-grade SIL pathologically diagnosed by colposcopy-assisted biopsy. Multivariate logistic analysis showed that whether colposcopic examination was satisfactory or not and cervical cytology before colposcopy were independent risk factors of missed CIN2 + in low-grade SIL pathologically diagnosed by colposcopy-assisted biopsy (OR:2. 06 and 4. 67 respectively). Conclusion The accuracy of colposcopy-assisted biopsy for the diagnosis of CIN, remains poor. Whether colposcopic examination is satisfactory or not and cervical cytology before colposcopy are independent risk factors of missed CIN2 + in low-grade SIL pathologically diagnosed by colposcopy-assisted biopsy.