阴道镜引导活检诊断宫颈病变的优势与不足

目的:评价阴道镜引导宫颈活检(CDB)诊断宫颈病变的优势与不足。方法:1258例患者行宫颈LEEP术前均行CDB,比较两者病理组织学诊断的符合率,计算CDB对高级别宫颈病变的漏诊率及CDB诊断高级别宫颈病变的阴性预测值。结果:CDB和LEEP病理组织学诊断完全相符占42.5%,CDB诊断病变级别更高占42.1%,更低占15.4%。CDB准确性为84.6%。CDB诊断为低级别CIN经LEEP术后病理证实21.3%存在高级别CIN。CDB诊断为低级别CIN和高级别CIN实际上存在宫颈浸润癌的比例为0.9%及4.4%,两者有显著差异(P<0.05)。CDB诊断高级别CIN的阴性预测值为78.5%;CDB用于诊断宫颈浸润癌漏诊率为2.2%。结论:阴道镜检查和CDB,可以发现绝大部分的宫颈病变患者。单纯点活检不能排除宫颈浸润癌。CDB诊断为高级别宫颈病变时,应考虑有更重病变的可能,LEEP可弥补CDB的不足,最大限度地提高宫颈疾病诊断的准确性。     

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。     

260例电子阴道镜下图像特点与宫颈活检病理诊断的关系

目的:探讨电子阴道镜下的宫颈异常表现图像与宫颈活检病理诊断的相互关系。方法:选择2011年9～11月就诊于本院阴道镜门诊的260例患者,以活检病理学诊断结果为标准,对组织病理学结果和阴道镜表现特点进行分析。结果:①电子阴道镜在宫颈疾病诊断中敏感性97.9%,特异性71.2%,阳性预测值89.7%,假阴性率2.1%;②阴道镜下扁平醋白上皮可出现在宫颈炎到CINⅢ的各级宫颈病变中,致密醋白上皮出现于CINⅡ及以上级别的宫颈病变中。二联征中CIN的检出率为77.4%,三联征和醋白上皮+非典型血管中CINⅢ及宫颈癌(ICC)的检出率分别是78.6%和72.4%。③不典型鳞状上皮(ASC)和(或)非典型腺细胞(AGC)出现在各级宫颈病变,在低度鳞状上皮内瘤变(LSIL)中CINⅠ的检出率为40.9%,在高度鳞状上皮内瘤变(HSIL)(包括HSIL+AGC)中CINⅡ、CINⅢ及ICC的检出率为96.9%。④宫颈表面是否光滑及糜烂程度与宫颈自身病变无关。结论:电子阴道镜是辅助诊断宫颈疾病的可靠而重要的手段,典型的异常阴道镜图像对诊断宫颈癌前病变和宫颈癌有重要价值。     

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...     

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。     

阴道镜下常规活检诊断宫颈上皮内瘤样病变108例分析

目的：通过阴道镜下常规活检，探讨宫颈上皮内瘤样癌变（CIN）的检查率、镜图像特征及诊断价值。方法：回顾分析5年来阴道镜检查834例中108例CIN的阴道镜检结果。结果：834例中CIN发现108例，占12．8％，CIN的异常阴道镜像主要为血管异常及腺口白环、白腺。结论：阴道镜是辅助诊断CIN的重要方法，初次阴道镜检可疑时应进行常规活检。     

阴道镜检查280例临床分析

目的评价阴道镜检查在宫颈病变诊断中的价值。方法2004年12月-2005年6月我院对有宫颈病变的280例门诊病人进行阴道镜检查并以改良Reid评分，其中有218例同时接受病理检查。结果病理确诊为宫颈不典型增生（CINⅠ～Ⅲ）8例，其中CINⅠ4例，CINⅡ3例，CINⅢ1例；宫颈原位癌1例、宫颈浸润癌1例、慢性宫颈炎113例、宫颈息肉80例及HPV感染者15例。与阴道镜检查结果对照，浸润癌1例在镜下诊断癌疑，1例原位癌及8例CIN的改良评分为1—5分，而慢性宫颈炎则为0～1分。结论阴道镜检查对宫颈癌、宫颈癌前病变、HPV感染的早期诊断具有较好的筛查作用，但由于评价的标准包含着一定的主观因素，因而不能作为确诊依据。     

液基细胞学筛查妊娠期妇女宫颈病变的临床研究

目的 探讨液基细胞学检查用于妊娠期妇女宫颈病变筛查的安全性和妊娠期宫颈病变的特征.方法 应用液基细胞学检查方法,分别对在本院就诊的1951例妊娠期妇女（A组）和3752例同龄非妊娠期妇女（B组）及5069例同期、同龄进行健康检查妇女（C组）的宫颈脱落细胞进行宫颈病变筛查,依据目前国际通用的Bethesda系统（TBS）分类标准进行诊断,对有宫颈病变的非妊娠期妇女同时进行阴道镜检查,必要时进行镜下活检,依据病理学检查结果给予必要的临床处理和随访.结果 （1）宫颈病变总发生率A组为23.58%（460/1951）,B组为19.22%（721/3752）,C组为13.40%（679/5069）,3组分别比较,差异均有统计学意义（P＜0.01）.（2）在宫颈病变中以感染为主, A组宫颈感染发生率为19.02%（371/1951）,B组为10.66%（400/3752）,C组为9.23%（468/5069）,A组宫颈感染发生率明显高于B、C两组,差异有统计学意义（P＜0.05）.（3）A组宫颈鳞状上皮内病变的发生率为1.13%（22/1951）,而非妊娠的B、C两组宫颈鳞状上皮内病变的总发生率为1.24%（109/8821）,两者比较,差异无统计学意义（P＞0.05）.（4）A组宫颈腺上皮细胞不典型增生的发生率为0.62%（12/1951）,C组为0.95%（48/5069）,两组比较,差异无统计学意义（χ^2=1.37,P＞0.05）. （5）A组妇女行TCT检查后有49例发生出血,局部压迫后止血;孕早期行TCT检查者,无一例出血发生.结论 妊娠期妇女与非妊娠期妇女宫颈病变发生率相似;液基细胞学检查用于妊娠期妇女宫颈病变的筛查安全、可行.     

TERC基因联合阴道镜及HPV检测在早期宫颈病变诊断中的应用

目的：探讨阴道镜、人端粒酶RNA组分（hTERC）基因扩增和人乳头瘤病毒（HPV）分型检测在早期宫颈病变诊断中的临床意义。方法：对经阴道镜初步诊断为宫颈病变的219例患者,应用荧光染色体原位杂交（FISH）技术检测hTERC基因扩增、表面等离子谐振技术（SPR）检测HPV感染情况,并进行统计学分析。结果：①阴道镜诊断宫颈CINⅠ级59例,CINⅡ级76例,CINⅢ级56例,宫颈癌28例,与组织学最终诊断相比较,两种方法有相关性（P＜0.05）。②hTERC基因在宫颈炎性病变、CINⅠ、CINⅡ、CINⅢ及宫颈鳞癌中的阳性扩增率分别为7.9%,10.9%,44.6%,63.2%和82.6%,各组间比较差异有统计学意义（P＜0.000 1）。③132例进行HPV分型检测的患者中,高危亚型感染54例,低危亚型感染29例,阴性49例, HPV阳性患者的感染类型同宫颈上皮内瘤变等级有关（P=0.041 9）。④同时进行hTERC基因及HPV检测患者中,54例HPV高危亚型患者hTERC基因发生异常扩增者33例,29例低危亚型中发生异常扩增7例,组间比较差异有统计学意义（P＜0.01）。结论：阴道镜作为宫颈病变的初诊手段有一定的漏诊和过度诊断;HPV高危亚型感染可能是导致hTERC基因异常扩增的因素之一;hTERC基因扩增和HPV感染与宫颈高级别病变的进展密切相关,可能是导致宫颈癌发生的直接诱因;阴道镜、HPV和hTERC基因联合检查是判断早期宫颈病变进展并做出诊断的有效手段。     

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.     

活检组织快速石蜡切片病理检查在子宫颈病变诊治中的应用

目的 评价活检组织快速石蜡切片病理检查在宫颈病变诊治中的应用价值.方法 选择2009年9月至2010年1月在山东大学齐鲁医院行宫颈癌筛查异常者(包括细胞学检查异常及高危型HPV持续阳性)共176例,随机分为两组.A组:87例,首先采用宫颈Belinson活检钳在阴道镜指示下行宫颈多点活检,然后利用超声组织处理仪和BT生物组织透明剂制作快速石蜡切片,行病理检查;B组:89例,在阴道镜指示下行官颈多点活检,制作常规石蜡切片,行病理检查.比较两组的切片质量、制片时间.对A、B组中诊断为宫颈上皮内瘤变(CIN)Ⅱ及以上病变、特殊情况的CIN Ⅰ患者行手术治疗,手术方式包括宫颈环形电极切除术(LEEP)、官颈冷刀锥切术(CKC)、子宫切除术或宫颈癌根治术,手术标本术后进行常规病理检查,当活检组织(包括快速或常规)病理检查和术后标本常规病理检查结果 不符时,以两者中诊断结果 较重者为最终诊断,比较A、B组的活检组织病理检查结果 与最终诊断的符合率.结果 A、B组切片质量均为满意或基本满意,能够满足诊断要求,切片合格率均为100%.A、B组的制片时间平均分别为40 min和1 d,两组比较,差异有统计学意义(P<0.05).A、B组中行手术治疗的患者分别为30、32例,其活检组织病理检查结果 与最终诊断的符合率分别为93%(28/30)和9l%(29/32),两组比较,差异无统计学意义(P>0.05).结论 活检组织快速石蜡切片病理检查诊断宫颈病变准确可靠、快速经济,有推广使用价值.

Abstract：

Objective To evaluate the application of pathological diagnosis by rapid paraffin sections in the diagnosis and treatment of cervical diseases. Methods A total of 176 cases from our hospital between September 2009 and January 2010 with abnormal cervical cancer screening (including abnormal cytology result and high-risk HPV continuous positive) were randomly divided into 2 groups. Eighty-seven cases of them whose biopsy were got by Belinson forceps under the direction of colposcopy with rapid paraffin sections by ultrasonic histopathological rapid processor and BT transparent agents were selected as group A, while 89 cases with conventional paraffin sections were selected as group B. The production time and quality for paraffin sections were analyzed in the two groups. Those diagnosed as cervical intraepithelial neoplasia (CIN)Ⅱ or even worse and some special patients with CIN Ⅰ in the two groups received surgery, including loop electrosurgical procedure (LEEP) ,cold knife conization (CKC),.hysterectomy or radical hysterectomy.Tissue obtained after surgery was sent for routine pathological examination. If the results of postoperative routine pathological examination were inconsistent with the rapid or routine biopsy pathological examination,the heavier results were regard as the final diagnoses. The pathological results and diagnose accordance rates were recorded and compared between group A and group B. Results The quality of sections in two groups were all satisfied or basically satisfied to meet the diagnostic requirements. There were statistically significant difference in average production time between group A and B (40 minutes vs 24 hours, P < 0. 05). Thirty patients in group A and 32 patients in group B received surgery. The coincidence rate of biopsy pathological results and final diagnoses were 93% (28/30) for group A and 91% (29/32) for group B, in which there were not statistically significant difference (P > 0. 05). Conclusion Bapid paraffin sections technology is safe, accurate and economical for rapid pathological diagnosis of cervical diseases, which is worthy for being widely used in hospitals.     

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.     

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。     

口腔HPV携带者子宫颈病变的发病风险分析

目的 通过人群调查,分析口腔HPV携带者中宫颈病变[包括宫颈上皮内瘤变(CIN)和宫颈癌]的发病风险.方法 选取2009年1月至2011年12月在上海地区3个临床中心(包括上海交通大学医学院附属仁济医院、上海市第一妇婴保健院和上海市奉贤区中心医院)诊治的1200例门诊患者(包括行年度体检和门诊就诊患者)和50例术前诊断为CINⅢ、宫颈癌的住院患者,以荧光定量PCR技术检测其口腔HPV感染情况.对其中1200例门诊患者进行横断面队列分析,比较口腔HPV阳性和阴性者之间宫颈病变发生率的差异,并分析口腔HPV感染患者的人口～行为学特征;另对1250例门诊和住院患者进行病例-对照分析,比较宫颈正常者与宫颈病变患者口腔HPV感染的差异,分析宫颈病变发病的主要危险因素.结果 荧光定量PCR技术检测显示,1200例门诊患者中,口腔HPV阳性71例,占5.9％ (71/1200);50例住院患者中,口腔HPV阳性16例,占32.0％ (16/50).横断面队列分析显示,1200例门诊患者中,共发现宫颈病变患者(包括CIN Ⅰ和CINⅡ)18例,口腔HPV阳性(71例)和阴性(1129例)患者的宫颈病变发生率分别为4.2％ (3/71)和1.3％ (15/1129),两者比较,差异有统计学意义(P＜0.05);口腔HPV阳性者发生CIN Ⅰ和CINⅡ的相对危险度分别为2.9和4.0;口腔HPV阳性者口交频繁(包括口交频度为经常和一直者)及性伴侣数＞3个者显著多于口腔HPV阴性者(P＜0.01).病例-对照分析显示,1250例门诊和住院患者中,宫颈正常者(1182例)口腔HPV阳性率为5.8％ (68/1182),宫颈病变者(68例)口腔HPV阳性率为27.9％(19/68),其中CIN Ⅰ、CINⅡ、CINⅢ、宫颈癌患者口腔HPV阳性率分别为2/13、1/5、31.4％ (11/35)和5/15,CIN Ⅰ、CINⅡ、CINⅢ、宫颈癌患者口腔HPV阳性率分别与宫颈正常者比较,差异均有统计学意义(P＜0.01).口腔HPV阳性者发生CIN Ⅰ、CINⅡ、CINⅢ和宫颈癌的比值比分别为3.1(95％CI:1.6～10.1)、4.2(95％ CI:1.7 ～ 28.4)、7.1 (95％ CI:4.8 ～ 19.8)和10.1 (95％ CI:3.2 ～ 32.1).以多元logistic回归模型对宫颈病变者和宫颈正常者的人口-行为学特征分析表明,口交频繁、多个性伴侣是HPV口腔-宫颈共同感染及宫颈病变发病的高危因素.结论 口腔和宫颈之间,HPV有复杂多样的传播方式,应对口腔HPV携带者的HPV相关性宫颈病变加以重视,并给予综合治疗.     

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。