阴道镜下宫颈活检低诊断CIN2及以上病变的影响因素分析

目的：评价阴道镜下活检诊断CIN1的准确性,分析低诊断CIN2及以上病变的影响因素。方法回顾性分析126例阴道镜下活检诊断为CIN1,短期内行宫颈环形电切术（LEEP）的病例资料,对照比较术前术后组织病理学诊断的符合率。应用Logistic回归分析进行多因素分析。结果 LEEP术前后CIN1的符合率为53.17%（67/126）,CIN2及以上病变低诊断为CIN1的比例为46.83%（59/126）。绝经、HSIL及以上病变、HR- HPV阳性是阴道镜下宫颈活检低诊断CIN2及以上病变的独立高危因素,其相对危险度OR分别为3.442、3.747、2.368。结论阴道镜下活检诊断CIN1中存在CIN2及以上病变的低诊断。阴道镜下宫颈活检诊断CIN1时要重视绝经、HSIL及以上病变和HR- HPV阳性等因素,参考细胞学诊断进行确诊。

Factors related to under-diagnosis of CIN2 and above lesions in CIN1 lesions diagnosed by colposcopic biopsy

Objective To investigate the factors related to under- diagnosis of cervical intraepithelial neoplasia 2（CIN2） or above lesions in CIN1 lesions diagnosed by colposcopic biopsy. Methods The clinical data of 126 patients diagnosed as CIN1 lesions by colposcopic biopsy, who then underwent loop electrosurgical procedure （LEEP） ,were retrospectively analyzed. The coincidence of histopathological diagnosis between colposcopic biopsy and LEEP was evaluated. The related factors to un-der- diagnosis were analyzed by multivariate Logistic regression. Results Among 126 CIN1 cases diagnosed by colposcopic biopsy, 67 cases（53.17%） were consistent with histopathological results after LEEP and 59 cases（46.83%） were under- diagnosed CIN2 or above lesions. Logistic regression analysis showed that menopause, cytological diagnosis of high grade squamous in-traepithelial lesion （HSIL） and positive HR- HPV were the risk factors of under- diagnosis of CIN2 or above lesions in CIN1 cases diagnosed by colposcopic biopsy （OR： 3.442, 3.747 and 2.368 respectively）. Conclusion CIN2 and above lesions may un-der- diagnosed in colposcopic biopsy, the factors related to under- diagnosis should be avoided.