阴道镜检查对宫颈上皮内瘤样病变的诊断价值探讨

目的 探讨阴道镜对宫颈上皮内瘤样病变（CIN)的诊断价值。方法 分析我院近年宫颈疾患701例阴道镜的检查结果。结果 CIN检出率阴道镜组显著高于肉眼检查组，且以30～49岁段为主，占68．5％。阴道镜图像中以血管异常为主占59％。阴道镜下活检与术后病理诊断的符合率为75％。结论 阴道镜是辅助诊断CIN的重要环节，可以提高CIN检出率。     

阴道镜对宫颈上皮内瘤样病变的诊断价值分析

宫颈上皮内瘤样病变(cervical immepithelial neoplasia，CIN)是宫颈浸润癌演变发展过程中的癌前期病变阶段。对此阶段早期诊断和治疗是防治宫颈癌的关键环节。本研究采用阴道镜检查直接观察宫颈表面病变做出诊断，同时镜下定位活检，病理检查为最后诊断，同时以此做标准，以评价阴道镜检查对CIN的诊断价值。     

阴道镜对宫颈上皮内瘤变的诊断价值

目的：评价阴道镜检查对宫颈上皮内瘤样病变（CIN）的诊断价值。方法：对1991年5月至2002年4月进行阴道镜检查的患者1407例，行镜下定位取活组织病理检查。结果：近4年来CIN的发病例数呈上升趋势，发病年龄在30－39岁的病例占80．29％，经病理确诊CIN406例，包括CIN Ⅰ209例，CINⅡ104例和CINⅢ（包括CIS）93例；慢性宫颈炎625例，湿疣187例，息肉139例，其他50例（包括宫颈纳氏囊肿28例，子宫内膜异位症13例，乳头状瘤9例），阴道镜检查对CIN的诊断准确性为79．67％，敏感性为96．06％，特异性为73．03％，阳性预测值为59．095，阴性预测值为97．86％。CIN在阴道镜下的图像以醋酸白色上皮的出现率最高为83．50％，对CIN诊断的敏感性和阴性预测值高；与点状区和（或）镶嵌同时存在时，对CIN诊断的敏感性下降，特异性升高，结论：阴道镜检查对CIN的诊断价值在于其敏感性和阴性预测值高，在国内适合作为CIN的筛查方法，统一阴道镜的评分标准意义重大。     

744例宫颈上皮内瘤样病变的诊断分析

目的　分析宫颈上皮内瘤样病变 (CIN) 10年来发病情况 ,并对其筛查诊断方法进行回顾性分析。方法　回顾总结 1993年 1月～ 2 0 0 2年 12月经阴道镜检查并行宫颈活组织检查的 2 10 7病人 ,检出 74 4例CIN ,分析CIN检出的情况及宫颈涂片细胞学和阴道镜检查对其诊断的意义。结果　CIN的检出率逐年升高 ,宫颈涂片细胞学人工阅片筛查CIN的敏感度为 4 3 9% ,电脑辅助细胞学分析系统 (CCT)筛查CIN的敏感度为72 7% ,阴道镜诊断CIN的敏感度为 88 0 %。 35岁以下未明确诊断意义的不典型鳞状上皮细胞 (ASCUS)患者中CIN检出率明显高于 35岁以上者 ,差异有显著性。结论　CCT对CIN的检出有明显提高 ,优于人工阅片 ,阴道镜指导下宫颈活组织检查是诊断CIN的敏感方法。 35岁以下ASCUS患者的处理更应重视     

宫颈上皮内瘤样病变的诊断和处理

1　宫颈上皮内瘤样病变宫颈上皮内瘤样病变 (ｃｅｒｖｉｃａｌｉｎｔｒａｅｐｉｔｈｅｌｉａｌｎｅｏｐｌａｓｉａ ,ＣＩＮ)是指子宫颈癌的癌前病变 ,它包括宫颈非典型增生(ｃｅｒｖｉｃａｌｄｙｓｐｌａｓｉａ)及子宫颈原位癌 (ｃａｒｃｉｎｏｍａｉｎｓｉｔｕ ,ＣＩＳ) ,两者的上皮变化性质相同 ,程度不同。根据细胞异常的程度将ＣＩＮ分为三级 ,ＣＩＮⅠ级相当子宫颈轻度非典型增生 ;ＣＩＮⅡ级相当子宫颈中度非典型增生 ;ＣＩＮⅢ级相当子宫颈重度非典型增生和 (或 )子宫颈原位癌。ＣＩＮⅠ、ＣＩＮⅡ和ＣＩＮⅢ发展为癌的危险性分别为1…     

宫颈上皮内瘤样病变临床诊断方法的分析

目的　探讨宫颈细胞学、阴道镜和宫颈活检联合检测对宫颈病变的诊断价值。方法　对宫颈细胞学异常 ,进行阴道镜检查及镜下多点活组织病理检查 195例患者的临床资料进行回顾性分析。结果　电脑辅助细胞学检测系统 (CCT)检查共 195例。未明确诊断意义的不典型磷状上皮细胞 (ASCUS) 90例中 ,宫颈活检病理为炎症 2 6例 (30 % ) ;CIN 6 3例 (70 % ) ,其中 ,CINⅠ 5 2例 (5 7 78% ) ,合并人乳头状瘤病毒 (HPV)感染14例 (15 5 6 % ) ;CINⅡ 6例 (6 6 7% ) ;宫颈上皮内瘤样病变 (CIN)Ⅲ 5例 (5 5 6 % )。细胞学诊断低度磷状上皮内瘤变 (LSIL) 71例 ,其中 17例 (2 3 94 % )为炎症 ,符合低度病变为 4 5例 (6 3 38% ) ,高度病变为 9例(12 6 8% ) ,LSIL合并HPV感染 2 4例 (33 8% ) ,病理检查合并HPV感染 2 4例 (33 8% )。细胞学诊断高度磷状上皮内瘤变 (HSIL) 2 8例 ,其中低度病变为 8例 (2 8 5 7% ) ,符合高度病变为 18例 (5 7 14 % )。微小浸润癌 1例(3 5 7% )。结论　细胞学筛查异常者 ,应结合阴道镜下多点活检进一步诊断 ,有利于提高CIN的检出率。有性生活的妇女应定期进行细胞学筛查或阴道镜检查     

LEEP治疗宫颈上皮内瘤样病变108例临床探讨

宫颈上皮内瘤样病变（CIN）是宫颈癌前期病变的一个过程，早期发现并及时治疗CIN可降低宫颈癌的发生率。本文对我院2003年10月～2005年5月，通过TCT（薄层液基细胞学），阴道镜检查及镜下活检。行LEEP治疗宫颈上皮内瘤样病变108例现报告如下。     

宫颈上皮内瘤样病变的手术治疗

1 背景 目前宫颈上皮内瘤样病变（CTV）的治疗主要是根据疾病的性质和范围行局部切除或切除。阴道镜检查出现以前，传统上所有病灶在全麻下都用刀行锥切活检或电凝法行点根治术，而现在更趋向于各种可用于门诊病人的更保守的局部切除和切除治疗。     

宫颈上皮内瘤样病变的诊断与治疗

目的:研究宫颈锥切术对宫颈上皮内瘤样病变的诊断及治疗价值。方法:对2009年11月至2010年10月在我院行阴道镜下多点活检及宫颈锥切术等的44例患者进行回顾性分析,并运用自身对照法,对阴道镜下多点活检和宫颈锥切术的检查效果等进行统计学分析。结果:阴道镜下多点活检与宫颈锥切术病理检查不符合者27例(61.4%),完全符合者17例(38.6%);在因早期浸润而行宫颈锥切术27例中,阴道镜下多点活检其病理检查结果完全符合的仅11例(39.3%),在宫颈锥切术后,对发现的早期浸润癌行广泛子宫切除术2例(4.5%);因CNⅡ级或Ⅲ及有微小浸润而行全子宫切术9例(20.5%);对行宫颈锥切术的33例患者进行术后随访,所有患者均保留了生育功能,且在18个月的随访中,未发现有患者宫颈细胞学检查结果异常。结论:宫颈锥切术在宫颈上皮内瘤样病变的诊断及治疗中具有重要的价值,阴道镜下的多点活检术不能将其取代。是临床值得推荐的诊断及治疗方法,尤其对于具CINⅢ级且想保留生育功能患者。     

The increased detection of cervical intraepithelial neoplasia when using a second biopsy at colposcopy

Objective

It has been suggested that colposcopy can miss a significant percentage of high-grade cervical intraepithelial neoplasia (CIN2 +). Improved disease ascertainment was evaluated by taking multiple lesion-directed biopsies.

Methods

In a cross-sectional multicenter study in the Netherlands and Spain, 610 women referred to colposcopy following abnormal cervical cytology results were included. Multiple directed biopsies were collected from lesions and ranked according to impression. A non-directed biopsy of normal-appearing tissue was added if fewer than four biopsies were collected. We evaluated the additional CIN2 + yield for one and two directed biopsies. Colposcopic images were reviewed for quality control.

Results

In women with at least two lesion-directed biopsies the yield for CIN2 + increased from 51.7% (95%CI; 45.7–57.7) for one directed biopsy to 60.4% (95%CI; 54.4–66.2, p < 0.001) for two biopsies. The highest CIN2 + yield was observed in women who were HPV16-positive, had high-grade squamous intraepithelial lesion (HSIL) cytology, and high-grade colposcopy impression. The yield increased from 83.1% (95%CI; 71.5–90.5) with one directed biopsy to 93.2% (95%CI; 83.8–97.3) with two directed biopsies. Only 4.5% additional CIN2 + were detected in biopsies not targeting abnormal areas on the cervix.

Conclusions

A second lesion-directed biopsy is associated with a significant increase in CIN2 + detection. Performing a second lesion-directed biopsy and using a low threshold for abnormality of any acetowhitening should become the standard clinical practice of colposcopy.     

Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse

OBJECTIVES: The purpose of this study was to determine the relative importance of colposcopically directed biopsy, random biopsy, and endocervical curettage (ECC) in diagnosing > or =cervical intraepithelial neoplasia (CIN) II.Study design During a screening study, 364 women with satisfactory colposcopy and > or =CIN II were diagnosed. All colposcopically detected lesions were biopsied. If colposcopy showed no lesion in a cervical quadrant, a random biopsy was obtained at the squamocolumnar junction in that quadrant. ECC was then performed. RESULTS: The diagnosis of > or =CIN II was made on a colposcopically directed biopsy in 57.1%, random biopsy in 37.4%, and ECC in 5.5% of women. The yield of > or =CIN II for random biopsy when cytology was high grade (17.6%) exceeded that when cytology was low grade (2.8%). One of 20 women diagnosed solely by ECC had invasive cancer. CONCLUSION: Even when colposcopy is satisfactory, ECC should be performed. If cytology is high grade, random biopsies should be considered.     

宫颈冷刀锥切术诊治宫颈上皮内瘤变Ⅲ级320例临床分析

目的:探讨宫颈锥切术在宫颈上皮内瘤变Ⅲ级(CINⅢ)的诊断与治疗中的价值。方法:回顾性分析因宫颈CINⅢ行宫颈锥切术的患者320例,采用自身对照法,对比研究宫颈锥切术和阴道镜下活检的病理结果。结果:宫颈锥切术与阴道镜下检查的病理结果完全符合者187例(58.44%),不符合者133例(41.56%)。锥切术后病理诊断级别下降者69例(21.56%),漏诊微小浸润癌60例(Ⅰa1期55例,Ⅰa2期5例)(18.75%),漏诊浸润癌(Ⅰb1期)4例(1.25%)。59例患者再次行子宫切除术,其中32例(54.24%)术后病理转阴,16例病理诊断级别降低。宫颈锥切术的主要并发症是术后出血。结论:宫颈锥切术在CINⅢ的诊断和治疗中具有重要价值。应根据患者年龄、病变程度、切缘状态、生育要求等多方面个体化、综合考虑以决定进一步的治疗方案。     

子宫颈锥切术在子宫颈上皮内瘤变诊断和治疗中的价值

目的 明确宫颈锥切术能否被阴道镜下多点活组织检查（活检）代替以及探讨宫颈锥切术在宫颈上皮内瘤变（CIN）诊断与治疗中的价值。方法 回顾性分析近5年来,因宫颈病变同时行宫颈细胞学检查、阴道镜下多点活检和宫颈锥切术的患者54例,采用自身对照法,对比研究宫颈锥切术和阴道镜下多点活检的病理检查结果。结果 宫颈锥切术与阴道镜下多点活检的病理检查结果完全符合者22例（40.7%),不符合者32例（59.3%)。在因除外浸润癌而行宫颈锥切术的31例中,与阴道镜下多点活检的病理检查结果一致者仅13例（41.9%)。宫颈锥切术后,因发现早期浸润部,行广泛子宫切除术者2例（3.7%);因CINⅢ级（CINⅢ）或微小逮润癌行全子宫切除术者13例（24.1%)。39例（73.2%)患者宫颈锥切术后密切随诊,保留了生育功能,在平均为18.3个月的随诊期内,无一例出现宫颈细胞学检查异常,其中3例妊娠并已分娩,宫颈锥切术主要的并发症是术后出血。结论 宫颈锥切术在CIN治疗中具有举足轻重的重要价值。它不能被阴道镜下多点活检所取代,对于患者CINⅢ又要保留生育功能的年轻患者,宫颈锥切术是较为适当的治疗方法。     

检出高级别子宫颈病变的阴道镜活检程序的优化

目的:探讨阴道镜下子宫颈活检对高级别子宫颈病变［即子宫颈上皮内瘤变Ⅱ级及以上病变（CIN Ⅱ +）］检出的价值,并通过基于不同风险条件组合的阴道镜检查实践,进一步优化阴道镜活检程序。 方法:前瞻性研究2017年4月至2019年12月在南京医科大学第一附属医院因子宫颈癌筛查结果异常转诊阴道镜检查的3...     

Primary care sector versus treatment centre follow up for post-treatment cervical squamous intraepithelial neoplasia (SIL)

Objective  The NHSCSP 2004 guideline recommends that the best practice for the follow up of post-treatment squamous intraepithelial neoplasia (SIL) is by cytological surveillance in the treatment centre or alternatively, in the primary care sector as a minimum standard. We undertook this study to test this recommendation. Setting  In a colposcopy clinic of a district general hospital of UK. Population  Retrospective analysis of 418 patients treated for squamous intraepithelial neoplasia whose post treatment cytological surveillance was followed up for 18 months after treatment. A prospective patient preference questionnaire was also undertaken in 50 randomly chosen patients having treatment to elicit their preferences for the place of follow up. Results  At 8 months 66.4% had their first smear in the primary care sector as compared to 88.6% in the treatment centre. The post-treatment follow up smear performance graph seems to be different for the primary care sector compared to treatment centre. In 12 months nearly 90% of the patients had at least one smear and by 18 months 96.9% of the treated patients had a follow up smear in the community which would detect residual disease. There was no statistically significant difference in the detection of residual disease in the community compared to the treatment centre during the follow up period. A total of 76% of patients preferred to have their follow up smears in the primary care. Conclusion  Targets set by the NHSCSP of UK were not met either by the primary care sector or the treatment centre in the 8 months but was satisfactorily achieved by both in 12 months. Recommendation  These preliminary results indicate a need for a larger multi centre randomised trial to establish if the primary sector is truly a satisfactory alternative for patient follow up. Cytological surveillance is best carried out in the place desired by the patients to allow good compliance with the monitoring process.     

阴道镜下宫颈活组织检查诊断孕妇宫颈病变的临床研究

目的 探讨阴道镜下官颈活组织检查(活检)诊断孕妇宫颈病变的临床价值和安全性.方法 采用队列研究方法,选择2007年8月1日至2009年2月28日在北京妇产医院产科门诊初次检查的孕13～34周、1年内未进行过宫颈液基薄层细胞学检查(TCT)的孕妇,先进行TCT筛查,对TCT结果异常者,在知情同意后进行阴道镜检查和阴道镜下宫颈活检.结果 (1)TCT:TCT筛查孕妇共计17 828例,其中TCT结果异常1502例,发生率为8.425%.(2)阴道镜检查:204例孕妇进行了阴道镜检查.阴道镜图像满意度为92.6%(189/204),阴道镜拟诊宫颈炎或宫颈上皮内瘤变(CIN)Ⅰ 125例,CIN Ⅱ25例,CIN Ⅲ或宫颈鳞状细胞癌(SCC)54例.(3)阴道镜下宫颈活检病理结果:204例行阴道镜检查者全部进行了宫颈活检,病理结果为宫颈炎及宫颈湿疣共33例,CIN Ⅰ 95例、CIN Ⅱ28例、CIN Ⅲ36例(包括官颈原位癌13例)、SCC Ⅰ a期12例.(4)符合度:与宫颈活检病理结果比较,阴道镜检查拟诊炎症和CIN Ⅰ 125例,其中113例与宫颈活检病理结果相同,符合率为90.4%(113/125),125例炎症和CIN Ⅰ患者中无一例病理结果为SCC.阴道镜检查拟诊CIN Ⅲ或SCC共54例中,23例活检病理结果为CIN Ⅲ、10例为SCC Ⅰ a期,符合率为61.1%(33/54例).(5)并发症:阴道镜检查及官颈活枪后,8例孕妇因官颈局部压迫止血无效行创面缝合止血,发生率3.9%(8/204),未发生其他与阴道镜检查和宫颈活检相关的不良事件.结论 对1年内未进行宫颈细胞学筛杏的孕妇进行TCT检查是必要的,对TCT结果异常者应进行阴道镜检查,阴道镜检查拟诊官颈炎或CIN Ⅰ者可以随诊,对阴道镜检查拟诊CIN Ⅱ及更高级别宫颈病变的孕妇,应行阴道镜下宫颈活检以明确病理学诊断.     

高级别子宫颈上皮内瘤变宫颈锥切及子宫全切除标本病变组织的病理特点

目的 探讨高级别宫颈上皮内瘤变(CIN,即CIN Ⅲ、Ⅲ)官颈锥切及子宫全切除术病变组织的形态特征、分布、生长方式及衍化特点等病理特点,为宫颈锥切治疗的深度和范围提供依据.方法 选择高级别CIN宫颈锥切标本及子宫全切除标本共592份,肉眼观察宫颈外口病变的形态特征,镜下观察高级CIN病变在各象限的分布特点.随机抽取其中200份标本,镜下观察其病变的深度、宽度及程度;观察病变细胞的特征、生长方式、衍化特点以及病变周围的间质反应情况.结果 (1)肉眼观察:宫颈光滑46份(7.8%),轻度糜烂151份(25.5%),中度以上糜烂395份(66.7%);合并宫颈肥大48份(8.1%)、宫颈赘生物4份(0.7%).(2)镜下观察:高级CIN病变在宫颈各象限的分布比例比较,差异无统计学意义(P>0.05).累及腺体深度<3 mm者188份(94.0%),3～5 mm者12份(6.0%),无一例>5 mm;累及腺体的宽度最宽为1.9 mm;累及腺体程度:孤立性累及腺体者77份(38.5%)、多灶性累及腺体者143份(71.5%)、融合性累及腺体者73份(36.5%);生长方式:平铺性生长162份(81.0%),内陷性生长98份(49.O%),外生性生长13份(6.5%);衍化特点:移行变化66份(33.O%),骤然变化167份(83.5%).高级别CIN有多种细胞类型,多数为基底细胞型,小圆细胞型;并有28.5%-45.0%的标本其病变周围有不同类型的免疫间质反应.结论 肉眼观察,高级别CIN病变无具有诊断意义的特征性改变;镜下观察,高级别CIN病变以平铺性生长、多灶性累及腺体以及累及腺体深度<3 mm为主,提示高级别CIN病变行宫颈锥切时既要注意切除的深度,又要注意切除面的范围.