阴道镜下宫颈活检诊断CIN1患者中漏诊CIN2+的相关因素分析

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.

Cervical intraepithelial neoplasia 2+ in low-grade squamous intraepithelial lesion pathologically diagnosed by colposcopy-assisted biopsy

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.