阴道镜下宫颈活检在诊断宫颈上皮内瘤变中的价值

目的:探讨阴道镜下宫颈活检在诊断宫颈上皮内瘤变中的价值。方法:回顾性分析2009年1月～2010年12月该院妇科门诊阴道镜下宫颈活检诊断为各类宫颈上皮内瘤变(CIN),并在短期内行宫颈电刀环切术、宫颈锥切术或子宫全切术的157例患者的临床资料。结果:157例患者中阴道镜下活检诊断结果与最后诊断符合者118例(75.2%),不符合者39例(24.8%),其中阴道镜下活检结果为CINI、CINII级和CINIII级与最后诊断符合率分别为62.9%、77.8%、82.6%,术后病理诊断降级18例,占11.5%(18/157),术后病理诊断升级21例,占13.4%(21/157),术后发现早期浸润癌4例(2.5%)。结论:重视宫颈疾病的早期筛查,重视阴道镜下活检在宫颈上皮内瘤变中的应用;阴道镜可提供准确的活检部位,提高活检阳性率,减少误诊率和漏诊率;阴道镜下宫颈活检虽有一定比例宫颈浸润癌的漏诊,但其仍然是一项方便、经济、创伤较小而又可靠的诊断CIN的方法。

The value of cervical biopsies under colposcopy in the diagnosis of cervical intraepithelial neoplasia

Objective:To evaluate the value of cervical biopsies under colposcopy in the diagnosis of cervical intraepithelial neoplasia.Methods:The clinical and pathological data of 157 patients with all types of CIN diagnosed by colposcopically directed cervical biopsies and then treated with loop electrosurgical excision procedure and(or) cervical conization and(or) hysterectomy in the short term in our hospital from January 2009 to December 2010 were analyzed retrospectively.Results:There were 118 cases(75.2%) of the diagnosis by colposcopically directed cervical biopsies were consistent and 39 cases(24.8%) cases were not consistent with the final diagnosis in 157 cases.The consistence rate of the CINI,II and III by colposcopically directed cervical biopsies and the final diagnosis were 62.9%,77.8%,82.6%,including 18 cases(11.5%)were pathologically diagnosed downgrade,21 cases(13.4%)were pathologically diagnosed upgrades,4 cases(2.5%) diagnosed as invasive cervical cancer.Conclusion:Great attention should be paid to early screening of cervical disease and application of the colposcopically directed cervical biopsies in cervical intraepithelial neoplasia;colposcopy can provide a accurate site for biopsy,increase positive rate of biopsy and reduce the rate of misdiagnosis.Although the colposcopically directed cervical biopsies have a certain proportion of missed diagnosis of invasive cervical cancer,but it is still a convenient,economical,less invasive and reliable method of diagnosis of CIN.