CAJ | 학술논문

【目的】评价液基薄层细胞学（TCT ）检查，电子阴道镜检查及镜下活检病理在高级别宫颈上皮内瘤变（CIN）的诊断价值。【方法】对本院2009年1月至2013年5月行TCT检查诊断为高度鳞状上皮内瘤变（HSIL）的247例患者，行电子阴道镜检查根据图像做出诊断并行活检送病理检查。对TCT结果与阴道镜活检的病理诊断及阴道镜下诊断与活检的病理诊断进行对比分析。对156例术前阴道镜活检病理与术后石蜡切片病理进行对照研究。【结果】247例 TCT 结果为 HSIL的患者中，宫颈阴道镜下活检病理诊断为高级别CIN即CINⅡ和 CINⅢ为221例（89．5％），浸润癌为5例（2．0％）。电子阴道镜在宫颈疾病诊断中敏感性为98．7％（231/234），阳性预测值95．9％（231/241）；阴道镜拟诊与活检病理学诊断的关系两组比较差异无统计学意义（P ＞0．05）。阴道镜活检病理与术后石蜡切片病理的比较差异有统计学意义（P ＜0．05）。【结论】TCT是筛查高级别CIN的有效方法；电子阴道镜是辅助诊断高级别CIN的可靠而重要的手段，典型的异常阴道镜图像是诊断高级别CIN和宫颈癌的重要手段；单独阴道镜下活检病理诊断不能替代术后诊断。
【목적】평개액기박층세포학（TCT ）검사，전자음도경검사급경하활검병리재고급별궁경상피내류변（CIN）적진단개치。【방법】대본원2009년1월지2013년5월행TCT검사진단위고도린상상피내류변（HSIL）적247례환자，행전자음도경검사근거도상주출진단병행활검송병리검사。대TCT결과여음도경활검적병리진단급음도경하진단여활검적병리진단진행대비분석。대156례술전음도경활검병리여술후석사절편병리진행대조연구。【결과】247례 TCT 결과위 HSIL적환자중，궁경음도경하활검병리진단위고급별CIN즉CINⅡ화 CINⅢ위221례（89．5％），침윤암위5례（2．0％）。전자음도경재궁경질병진단중민감성위98．7％（231/234），양성예측치95．9％（231/241）；음도경의진여활검병이학진단적관계량조비교차이무통계학의의（P ＞0．05）。음도경활검병리여술후석사절편병리적비교차이유통계학의의（P ＜0．05）。【결론】TCT시사사고급별CIN적유효방법；전자음도경시보조진단고급별CIN적가고이중요적수단，전형적이상음도경도상시진단고급별CIN화궁경암적중요수단；단독음도경하활검병리진단불능체대술후진단。
[Objective] To evaluate the value of thinprep cytologic test (TCT ) ,electronic colposcopy and colposcopically directed biopsy pathology in the diagnosis of high - level cervical intraepithelial neoplasia (CIN) .[Methods]A total of 247 patients with high squamous intraepithelial neoplasia(HSIL) diagnosed by TCT in our hospital from Jan .2009 to May 2013 received electronic colposcopy ,and were diagnosed by ima-ges .Cervical biopsies were performed for pathological examination .The results of TCT were compared with the results from electronic coloposcopy and colposcopically directed biopsy pathology .The pathology of 156 cases by colposcopy was compared with the pathology by paraffin section .[Results]Among 247 cases of HSIL by TCT ,221 cases(89 .5% ) were high -level CIN (CINⅡ and CINⅢ ) diagnosed by colposcopically directed biopsy pathology ,and 5 cases(2 .0% ) were infiltrating carcinoma .The sensitivity and positive predictive value of electronic colposcopy for the diagnosis of cervical disease were 98 .7% (231/234) and 95 .9% (231/241) ,re-spectively .There was no significant difference between colposcopy inspection and colposcopically directed bi-opsy pathology( P>0 .05) .There was significant difference between colposcopically directed biopsy pathology and postoperative paraffin section pathology ( P<0 .05) .[Conclusion] TCT is an effective method for screen-ing high-level CIN .Electronic colposcope is an important and reliable clinical examination method for the auxiliary diagnosis of high -level CIN .Typical abnormal cervical images under colposcopy have a critical diag-nostic value in high -level CIN and cervical cancer .Single colposcopically directed biopsy pathology can not take place of postoperative pathological diagnosis .