中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2015年
4期
263-267
,共5页
张凌%杜辉%张薇%Yang Bin%王纯%Jerome L Belinson%吴瑞芳
張凌%杜輝%張薇%Yang Bin%王純%Jerome L Belinson%吳瑞芳
장릉%두휘%장미%Yang Bin%왕순%Jerome L Belinson%오서방
宫颈上皮内瘤样病变%阴道镜检查%活组织检查%刮除术
宮頸上皮內瘤樣病變%陰道鏡檢查%活組織檢查%颳除術
궁경상피내류양병변%음도경검사%활조직검사%괄제술
Cervical intraepithelial neoplasia%Colposcopy%Biopsy%Curettage
目的：评价阴道镜下子宫颈多点活检及颈管内膜刮取术（ECC)对高级别子宫颈病变[指子宫颈上皮内瘤变（CIN）Ⅱ及以上病变]的诊断价值。方法2009年4月—2010年4月进行的深圳子宫颈癌筛查项目Ⅱ（SHENCCASTⅡ）是以子宫颈液基细胞学检查联合HPV检测[包括HPV DNA分型和第2代杂交捕获（HC-Ⅱ）法]方法在10000例妇女中进行子宫颈癌筛查，对于上述筛查指标任一结果阳性（即子宫颈癌筛查阳性）者同时行阴道镜下子宫颈多点活检及ECC，对其活检组织（包括多点活检和ECC）进行病理检查。实施阴道镜检查并获得有效病理检查结果及保存有清晰阴道镜图像者共2558例，其中阴道镜下子宫颈4个象限均无异常（即阴道镜检查阴性）者1790例。对照其活检组织的病理诊断，分析子宫颈细胞学检查与HPV检测结果提示高级别子宫颈病变的作用，探讨多点活检与ECC对诊断高级别子宫颈病变的价值。结果2558例行阴道镜检查妇女中，阴道镜检查阴性者1790例（69.98%，1790/2558），其中经多点活检及ECC获取的组织行病理检查后诊断为高级别子宫颈病变者共40例（2.23%，40/1790）。阴道镜检查阴性的40例高级别子宫颈病变患者中，细胞学检查为高级别鳞状上皮内病变（HSIL）和不能除外高度病变的鳞状上皮细胞（ASC-H）者与高级别子宫颈病变的患病高风险有关（OR值分别为28.37、15.07，P值分别为0.000、0.001）；HPV16、52、58、31、33、18型阳性者与高级别子宫颈病变的患病高风险有关（OR=3.11，P=0.017）；HC-Ⅱ法检测HPV阳性者与高级别子宫颈病变的患病高风险有关（OR=3.58，P=0.025）。2558例行阴道镜检查妇女中，≥40岁与<40岁者ECC阳性（ECC阳性指ECC获取的组织病理诊断为高级别子宫颈病变）率分别为40.7%（44/108）和19.2%（24/125），两者比较，差异有统计学意义（χ2=13.01，P=0.000）；≥40岁与<40岁者多点活检阳性（指多点活检组织病理诊断为高级别子宫颈病变）率分别为90.7%（98/108）、88.8%（111/125），两者比较，差异无统计学意义（χ2=0.24，P＞0.05）。40例阴道镜检查阴性的高级别子宫颈病变患者中，有32例在3项子宫颈癌高风险因素（即细胞学检查为HSIL或ASC-H，HPV16、18、52和58型中任一亚型阳性，HC-Ⅱ法检测HPV阳性）中至少有2项阳性。结论仅对阴道镜检查阳性者行子宫颈活检，会漏诊部分高级别子宫颈病变患者；对子宫颈癌筛查阳性者均行阴道镜下子宫颈多点活检及ECC，有利于减少漏诊。
目的：評價陰道鏡下子宮頸多點活檢及頸管內膜颳取術（ECC)對高級彆子宮頸病變[指子宮頸上皮內瘤變（CIN）Ⅱ及以上病變]的診斷價值。方法2009年4月—2010年4月進行的深圳子宮頸癌篩查項目Ⅱ（SHENCCASTⅡ）是以子宮頸液基細胞學檢查聯閤HPV檢測[包括HPV DNA分型和第2代雜交捕穫（HC-Ⅱ）法]方法在10000例婦女中進行子宮頸癌篩查，對于上述篩查指標任一結果暘性（即子宮頸癌篩查暘性）者同時行陰道鏡下子宮頸多點活檢及ECC，對其活檢組織（包括多點活檢和ECC）進行病理檢查。實施陰道鏡檢查併穫得有效病理檢查結果及保存有清晰陰道鏡圖像者共2558例，其中陰道鏡下子宮頸4箇象限均無異常（即陰道鏡檢查陰性）者1790例。對照其活檢組織的病理診斷，分析子宮頸細胞學檢查與HPV檢測結果提示高級彆子宮頸病變的作用，探討多點活檢與ECC對診斷高級彆子宮頸病變的價值。結果2558例行陰道鏡檢查婦女中，陰道鏡檢查陰性者1790例（69.98%，1790/2558），其中經多點活檢及ECC穫取的組織行病理檢查後診斷為高級彆子宮頸病變者共40例（2.23%，40/1790）。陰道鏡檢查陰性的40例高級彆子宮頸病變患者中，細胞學檢查為高級彆鱗狀上皮內病變（HSIL）和不能除外高度病變的鱗狀上皮細胞（ASC-H）者與高級彆子宮頸病變的患病高風險有關（OR值分彆為28.37、15.07，P值分彆為0.000、0.001）；HPV16、52、58、31、33、18型暘性者與高級彆子宮頸病變的患病高風險有關（OR=3.11，P=0.017）；HC-Ⅱ法檢測HPV暘性者與高級彆子宮頸病變的患病高風險有關（OR=3.58，P=0.025）。2558例行陰道鏡檢查婦女中，≥40歲與<40歲者ECC暘性（ECC暘性指ECC穫取的組織病理診斷為高級彆子宮頸病變）率分彆為40.7%（44/108）和19.2%（24/125），兩者比較，差異有統計學意義（χ2=13.01，P=0.000）；≥40歲與<40歲者多點活檢暘性（指多點活檢組織病理診斷為高級彆子宮頸病變）率分彆為90.7%（98/108）、88.8%（111/125），兩者比較，差異無統計學意義（χ2=0.24，P＞0.05）。40例陰道鏡檢查陰性的高級彆子宮頸病變患者中，有32例在3項子宮頸癌高風險因素（即細胞學檢查為HSIL或ASC-H，HPV16、18、52和58型中任一亞型暘性，HC-Ⅱ法檢測HPV暘性）中至少有2項暘性。結論僅對陰道鏡檢查暘性者行子宮頸活檢，會漏診部分高級彆子宮頸病變患者；對子宮頸癌篩查暘性者均行陰道鏡下子宮頸多點活檢及ECC，有利于減少漏診。
목적：평개음도경하자궁경다점활검급경관내막괄취술（ECC)대고급별자궁경병변[지자궁경상피내류변（CIN）Ⅱ급이상병변]적진단개치。방법2009년4월—2010년4월진행적심수자궁경암사사항목Ⅱ（SHENCCASTⅡ）시이자궁경액기세포학검사연합HPV검측[포괄HPV DNA분형화제2대잡교포획（HC-Ⅱ）법]방법재10000례부녀중진행자궁경암사사，대우상술사사지표임일결과양성（즉자궁경암사사양성）자동시행음도경하자궁경다점활검급ECC，대기활검조직（포괄다점활검화ECC）진행병리검사。실시음도경검사병획득유효병리검사결과급보존유청석음도경도상자공2558례，기중음도경하자궁경4개상한균무이상（즉음도경검사음성）자1790례。대조기활검조직적병리진단，분석자궁경세포학검사여HPV검측결과제시고급별자궁경병변적작용，탐토다점활검여ECC대진단고급별자궁경병변적개치。결과2558례행음도경검사부녀중，음도경검사음성자1790례（69.98%，1790/2558），기중경다점활검급ECC획취적조직행병리검사후진단위고급별자궁경병변자공40례（2.23%，40/1790）。음도경검사음성적40례고급별자궁경병변환자중，세포학검사위고급별린상상피내병변（HSIL）화불능제외고도병변적린상상피세포（ASC-H）자여고급별자궁경병변적환병고풍험유관（OR치분별위28.37、15.07，P치분별위0.000、0.001）；HPV16、52、58、31、33、18형양성자여고급별자궁경병변적환병고풍험유관（OR=3.11，P=0.017）；HC-Ⅱ법검측HPV양성자여고급별자궁경병변적환병고풍험유관（OR=3.58，P=0.025）。2558례행음도경검사부녀중，≥40세여<40세자ECC양성（ECC양성지ECC획취적조직병리진단위고급별자궁경병변）솔분별위40.7%（44/108）화19.2%（24/125），량자비교，차이유통계학의의（χ2=13.01，P=0.000）；≥40세여<40세자다점활검양성（지다점활검조직병리진단위고급별자궁경병변）솔분별위90.7%（98/108）、88.8%（111/125），량자비교，차이무통계학의의（χ2=0.24，P＞0.05）。40례음도경검사음성적고급별자궁경병변환자중，유32례재3항자궁경암고풍험인소（즉세포학검사위HSIL혹ASC-H，HPV16、18、52화58형중임일아형양성，HC-Ⅱ법검측HPV양성）중지소유2항양성。결론부대음도경검사양성자행자궁경활검，회루진부분고급별자궁경병변환자；대자궁경암사사양성자균행음도경하자궁경다점활검급ECC，유리우감소루진。
Objective To investigate the value of multiply biopsies and endocervical curettage (ECC)on diagnosing cervical lesions. Methods For the detection of cervical lesions, Shenzhen cervical cancer screening trial Ⅱ(SHENCCAST Ⅱ) program combined methods of HPV screening with liquid-based cytology(LBC), any positive indicators was then performed multiply biopsies and ECC under colopscopy. A total of 2 558 clear colposcopic images and pathological diagnoses were reviewed. To analyse the pathological results and primary screening results of the negative colopscopic images for discussing the value of multiply biopsies and ECC. Results Overall 2 558 women′s colposcopic images and sampling results were completed and validated. 69.98% (1 790/2 558) women had normal colposcopy appearances. Among them, 2.23%(40/1 790) were diagnosed as cervical intraepithelial neoplasiaⅡor worse (CINⅡ+). The odds ratio of high-grade squamous intraepithelial lesion(HSIL) was 28.37 (P=0.000) and atypical squamous cell cannot exclude HSIL(ASC-H)was 15.07 (P=0.001). HPV types 16,52,58,31,33 and 18 were related to high-grade cervical lesion with the odds ratio of 3.11(P=0.017). Hybrid captureⅡ(HC-Ⅱ)DNA test results shown that women with HPV positive were 3.58 times more risky than those of HPV negative, which was related to high-grade cervical lesion (P=0.025). Among the 2 558 women, CINⅡ+detective rate from ECC were 40.7%(44/108) in older group (≥40 years) were higher than that of 19.2%(24/125) in younger group(<40 years;χ2=13.01, P=0.000). CINⅡ+detective rate from multiply biopsies were 90.7%(98/108)in older group(≥40 years)were higher than that of 88.8%(111/125)in younger group (<40 years;χ2=0.24, P>0.05). The highest risky items of detecting CINⅡ+were as follows:(1)HSIL or ASC-H;(2)HPV types 16,18,52 and 58 positive(either one);(3)HC-ⅡHPV positive, at least 2 of the 3 items were included among 32 cases of the 40 CINⅡ+ with normal colposcopy appearances. Conclusions The results shown that only performed multi-site biopsies with abnormal colposcopy appearances may be missed some high-grade cervical lesion. For the positive indicators during screening should be performed randomly multi-sites biopsies and ECC under colopscopy, which may be helpful to reduce miss diagnosis.
