阴道镜直视下活检诊断宫颈上皮内瘤变准确性的评价

目的 评价阴道镜直视下活检诊断宫颈上皮内瘤变（CIN）的准确性。方法 回顾性分析近3年来阴道镜下活检诊断为CIN，并于短期内行宫颈环形电切术（LEEP）的153例患者的临床病理资料，采用自身对照对比研究阴道镜下活检和最终病理结果，并分析阴道镜直视下宫颈活检漏诊浸润性宫颈癌的相关因素。结果 153例患者中阴道镜下活检诊断结果同最后诊断符合者106例（69．3％），不符合者47例（30．7％），其中诊断过度者22例（14．4％），诊断不足者25例（16．3％）。153例患者中最终诊断为宫颈浸润癌18例，漏诊率为11．8％，细胞学检查结果为高度鳞状上皮内病变（HSIL）及以上者阴道镜下活检浸润性宫颈癌的漏诊发生率显著高于低度鳞状上皮内病变（LSIL）及以下者（x^2=8．208，P〈0．05）。结论 阴道镜直视下活检对确诊CIN尚不够可靠，存在着宫颈浸润癌漏诊的可能；细胞学检查结果为高度鳞状上皮内病变（HSIL）及以上时要警惕漏诊宫颈浸润癌的可能。

The accuracy of diagnosing cervical intraepithelial neoplasia with colposcopically directed biopsy

OBJECTIVE: To evaluate the accuracy of colposcopically directed biopsy in the diagnosis of cervical intraepithelial neoplasia (CIN). METHODS: The clinical data of 153 patients with CIN diagnosed by colposcopically directed biopsy and treated with cervical loop electrosurgical procedure (LEEP) shortly after were retrospectively studied. The consistency of pathological examination between colposcopically directed biopsy and LEEP was evaluated. The factors of missed diagnosis of cervical invasive carcinoma were analyzed. RESULTS: The diagnosis of 106 out of the 153 patients by colposcopically directed biopsy was consistent with that by LEEP as confirmed by pathologic diagnosis with a consistence rate of 69.3%, however, the diagnoses of 47 of the 153 patients by colposcopically directed biopsy were not consistent with those by LEEP, with an inconsistent rate of 30.7%, including 22 cases of overdiagnosis (14.4%, 22/153) and 25 cases of underdiagnosis (16.3%, 25/153). Eighteen patients were confirmed as with cervical invasive carcinoma by LEEP/hysterectomy at last with a missed diagnosis rate of 11.8%. The missed diagnosis rate of invasive carcinoma by colposcopically directed biopsy was significantly higher in the patients with cytologic diagnosis of with > or = HSIL than in the patients cytologically diagnosed as with < HSIL (chi(2) = 8.208, P < 0.05). CONCLUSION: The accuracy of diagnosing CIN with colposcopically directed biopsy is still unsatisfying. Attention should be paid on the patients with cytological diagnosis of > or = HSIL so as to avoid missed diagnosis of cervical carcinoma.