阴道镜下宫颈活检的准确性及宫颈癌漏诊相关因素分析

目的:探讨阴道镜下宫颈活检诊断宫颈上皮内瘤变(CIN)的准确性及其漏诊宫颈癌的相关因素分析。方法:回顾性分析阴道镜下宫颈活检确诊的587例CIN患者临床资料,均行宫颈LEEP术,以术后病理检查为金标准,观察阴道镜下宫颈活检CIN的准确性,并采用单因素及Logistic回归分析影响宫颈癌漏诊的相关因素。结果:587例患者阴道镜下活检与LEEP术后病理检查符合率为78.2%,病理级别上升50例(8.5%),其中漏诊浸润癌29例。术后提示病理降级的有78例(13.3%)。单因素分析显示:年龄≥55岁、阴道镜图像不满意、宫颈病变面积1/2者宫颈癌漏诊率较高,差异有统计学意义(P0.05),而HPV和TCT检测结果在影响宫颈癌漏诊率方面差异无统计学意义(P0.05)。Logistic回归分析示:年龄≥55岁、阴道镜图像不满意、宫颈病变面积1/2者均与宫颈癌的漏诊相关(P0.05)。结论:阴道镜检查对CIN的诊断存在一定的不准确性,可导致宫颈癌的误诊,提高临床医师对阴道镜的操作技能,积极多点活检,尤其关注阴道镜图像不满意患者和老年妇女是降低宫颈癌漏诊率的关键。

Accuracy of Colposcopy Biopsy in Diagnosis of Cervical Intraepithelial Neoplasia and Factor of Missed Diagnosis for Cervical Cancer

Objective:To analyze the accuracy of colposcopy biopsy in the diagnosis of cervical intraepithelial neoplasia(CIN) and the associated factors in missed diagnosis of cervical cancer.Methods:Clinical data's of 587 patients with CIN diagnosed by biopsy under colposcopy were retrospective analyzed.All patients underwent loop electrosurgical excision procedure(LEEP),with the postoperative pathology as the gold standard.In the diagnosis of CIN was observed,and related factors of missed diagnosis of cervical cancer were analyzed in single factor and logistic regression analysis method.Results:The coincidence rate of biopsy under colposcopy conforming to pathology examination after LEEP operation in 587 patients was 78.2％.50 (8.5％) of patients whose pathological level increased,including 29 cases of missed cervical carcinoma.There were 78(13.3％) of patients whose pathological level decreased.The single factor analysis showed that the missed diagnosis rates of cervical cancer in patients with age not less than 55 years old,without perfect colposcopy images,less than 1/2 of cervical lesion area were higher(P ＜ 0.05),but TCT and HPV test results had not relationship with the rate of misdiagnosis (P ＞ 0.05).Logistic regression analysis showed that age not less than 55 years old,without perfect colposcopy images,less than 1/2 of cervical lesion area were all related to the missed diagnosis rates of cervical cancer(P ＜0.05).Conclusions:Colposcopy is intuitive for diagnosis of cervical lesions,but still not accurate enough for the diagnosis of CIN.It is importance to reduce the rate of missed diagnosis of cervical cancer by strengthening the identification of cervical cytology,improving operational skills and particularly focusing on the cases with age not less than 55 years old,without perfect colposcopy images.