阴道镜下宫颈活检和宫颈环形电切术后病理检查对宫颈病变的诊断价值

目的 探讨阴道镜下宫颈活检、宫颈环形电切术(LEEP)后组织病理检查及两者联合对宫颈癌前病变及宫颈癌的早期诊断价值.方法 对554例经宫颈细胞学检查和(或)人乳头状瘤病毒检测异常,或筛查正常而肉眼观察宫颈柱状上皮中重度外翻者,行阴道镜下宫颈活检及LEEP,比较LEEP手术前后病理诊断的变化.结果 阴道镜下宫颈活检诊断结果与LEEP术后病理诊断结果的总符合率为49.82％.宫颈活检诊断为子宫颈上皮内瘤变(CIN)Ⅰ级的病例中,LEEP术后诊断为CINⅡ/Ⅲ级的占14.36％；宫颈活检诊断为CINⅡ/Ⅲ级(含原位癌)的病例中,LEEP术后诊断为浸润癌的占3.89％.两种方法诊断CINⅡ/Ⅲ级的一致性比较,Kappa值为0.62;阴道镜下宫颈活检、LEEP术后组织病理诊断CINⅡ/Ⅲ级与两者联合后的最终诊断比较,Kappa值分别为0.80和0.84,均有很高的一致性；阴道镜下宫颈活检诊断的总准确率为81.77％,对CINⅡ/Ⅲ级的漏诊率为20.64％.结论 阴道镜下宫颈活检、LEEP术后组织病理检查是诊断CIN及宫颈微小浸润癌的有效方法,阴道镜宫颈活检可能漏诊高级别CIN及宫颈微小浸润癌,两者联合可提高诊断的准确性.

Colposcopic cervical biopsy and pathology after loop electrosurgical excision procedure in diagnosis of cervical diseases

Objective To investigate the values of colposcopic cervical biopsy,pathology after loop electrosurgical excision procedure(LEEP) and the combined examinations of colposcopic cervical biopsy and LEEP in the early diagnosis of cervical precancerous lesions and cervical cancer.Methods Five hundred and fifty-four patients with abnormal findings in cervical cytology and/or human papillomavirus(HPV) test or with normal findings in these screening tests while having moderate to severe cervical columnar eversion were subject to colposcopic cervical biopsy and LEEP,and the pathological findings were compared before and after LEEP.Results The total coincidence rate of colposcopic cervical biopsy and pathology after LEEP was 49.82%.In patients diagnosed as cervical intraepithelial neoplasia(CIN) Ⅰ by cervical biopsy,14.36% were diagnosed as CINⅡ/Ⅲ after LEEP.In patients diagnosed as CIN Ⅱ/Ⅲ(including carcinoma in situ) by cervical biopsy,3.89% were diagnosed as invasive carcinoma after LEEP.Kappa coefficient was 0.62 in the consistency of diagnosis of CINⅡ/Ⅲ by two methods.Kappa coefficient was 0.80 in the consistency of diagnosis of CINⅡ/Ⅲ by colposcopic cervical biopsy and combined examinations of colposcopic cervical biopsy and LEEP,and that was 0.84 by pathology after LEEP and combined examinations of colposcopic cervical biopsy and LEEP.The total accuracy of colposcopic cervical biopsy was 81.77%,and the misdiagnosis rate of CINⅡ/Ⅲ was 20.64%.Conclusion Colposcopic cervical biopsy and pathology after LEEP are effective measures for diagnosis of CIN and microinvasive cervical carcinoma.Colposcopic cervical biopsy may misdiagnose high-level CIN and microinvasive cervical carcinoma,and the combined examinations can improve the accuracy of diagnosis.