宫颈上皮内瘤变108例临床分析

目的通过总结108例宫颈上皮内瘤变（CIN）的临床与预后，探讨分析CIN的诊断与治疗。方法归纳总结共108例各级CIN的临床特点及治疗方法，术前肉眼多点活检及阴道镜下活检与术后病理诊断的符合率，分析其预后。结果所有病人均有性生活史。除45／108（417％）无症状外，63／108（58．3％）有分泌物增多，或同房出血或阴道不规则流血。术前阴道镜下活检与术后病理诊断的符合率高于肉眼多．最活检符合率，但统计学差异无显著性，（P〉0．05）。根据病人要求、CIN级别及病变部位、范围采取不同的手术方式，其中14例随访超过5a，全部病人无1例复发，3、5a存活率均为100％。结论临床上对有性生活史的生育年龄妇女要警惕CIN，肉眼多点活检或阴道镜下活检可作为确诊手段，对不同的病人，依据病灶的性质，采用不同的手术方式，可避免复发，获100％的治愈率。     

Nucleic acid spot hybridization with nonradioactive labeled probes in screening for human papillomavirus DNA sequences

We examined 161 human tissue samples using the spot hybridization technique with nonradioactive labeled DNA probes of human papillomavirus (HPV). Whole cells were spotted on nitrocellulose filters; DNA of the cells was denatured and fixed to the filter. Then the DNA spots were hybridized to nonradioactive labeled DNA and monitored by a sandwich immunoenzymatic reaction. This technique is simple, sensitive, specific, requires no special equipment, and can be used in clinical settings. HPV DNA was found in 92% of samples in which, on the basis of histologic and colposcopic criteria, its presence was suspected, as well as in 31 samples where it was not suspected.     

Should punch biopsies be used when high-grade disease is suspected at initial colposcopic assessment? A prospective study

The reliability and applicability of colposcopically directed cervical punch biopsy was assessed in a sample of 170 paired punch and large loop excision of cervical transformation zone (LLETZ) specimens obtained from previously untreated women who had been selected for treatment on the basis of cytology and/or colposcopic findings and in whom the entire cervical transformation zone was visible. A single punch biopsy was taken immediately before the LLETZ, and all the specimens were reviewed by a single pathologist. Nine (5.3%) punch biopsies were inadequate. In terms of whether or not there was cervical intraepithelial neoplasia (CIN), the chance-corrected kappa analysis rated overall agreement as poor (kappa = 0.21, 95% confidence limits 0.02-0.39), whereas in terms of histologic grade, it was fair to moderate (kappa = 0.32, 95% confidence limits 0.23-0.42). Punch biopsy tended to underestimate the disease. The sensitivity and specificity of colposcopically directed punch biopsy for the detection of high-grade CIN was 74% and 91%, respectively, with positive- and negative predictive values of 97% and 48%, respectively. Two microinvasive and two intraepithelial glandular lesions were missed on punch biopsy. Punch biopsy should be avoided when high-grade disease is suspected.     

宫颈细胞学和电子阴道镜在宫颈病变早期诊断中的应用研究

目的进一步评价细胞学和电子阴道镜在宫颈病变的早期诊断中的价值.方法回顾性分析431例宫颈涂片和阴道镜检的结果,与活检组织病理学的结果进行对比研究.结果 431例中检出宫颈上皮内瘤变(CIN)Ⅰ 39例、CIN Ⅱ 36例、CIN Ⅲ 32例、宫颈鳞癌11例和宫颈湿疣27例,其余286例为慢性宫颈炎.宫颈涂片检出了93.5%宫颈病变,阴道镜检出了95.9%宫颈病变,细胞学与阴道镜下活检联合应用无漏诊.结论细胞学与阴道镜下活检联合应用能提高宫颈病变的检出率,阴道镜检查能明显提高宫颈湿疣的检出率.     

A registry-based study of follow-up failures in the screening experience of cervical cancer patients

Amadori A, Gentilini P, Bucchi L, Innocenti MP, Falcini F, Martini F, Fabbri M, Liverani M, Danesi S, Piantini B, Milandri C, Saragoni L, Amadori D. A registry-based study of follow-up failures in the screening experience of cervical cancer patients. Int J Gynecol Cancer 1998; 8 : 251–256.
Although all components of cervical screening are at risk of error, most studies of the previous screening experience of cervical cancer patients addressed only the false negative cytology results. Other reports showed the importance of screening failures not attributable to the Pap smear. We studied the relative frequency of all types of error observed in the screening history of 115 cervical cancer cases (median age, 60; range, 23–89) registered with the population-based Romagna Cancer Registry in Forlì (northern Italy) between 1986 and 1993. For each case, a search was made for all cytology, colposcopy, biopsy, and treatment reports issued prior to diagnosis. Eighty-one (70.4%) patients had never had a Pap smear. Eight (7.0%) were diagnosed at their first test. Twenty-six patients (22.6%) had had at least one previous smear. Among these, 10 were screened during the five years prior to diagnosis: three patients had false negative cytology results, one patient did not comply with the recommendation for an early repeat smear, two patients with positive cytology results underwent colposcopy with considerable delay (7 and 9 months), one patient had a negative colposcopy (without biopsy), and three patients had biopsies histologically reported as negative. An overview of the registry-based studies of screening histories reported so far from Italy (total number of cases 262) demonstrated that patients with serious shortcomings in follow-up after smear test, colposcopy, biopsy, clinical assessment, and treatment accounted for a substantial proportion of screening failures.     

高危型人类乳头瘤病毒检测对不典型鳞状细胞分流监测的临床价值

目的评价高危型人类乳头瘤病毒（HPV）检测对不典型鳞状上皮细胞（atypical squamous cells of undetermined significance，ASCUS）分流临测的临床价值。方法对654例宫颈细胞学检查结果为ASCUS的患者。进行高危型HPV检测和阴道镜检查，镜下定位活检可疑病灶．以病理学诊断作为金标准。结果654例中，高危型HPV检测呈阳性的病例为411例，阳性率为62.8％。经病理学确诊宫颈上皮内瘤样病变（CIN）病例为58例，占总数的8．9%（58／654），其中CIN Ⅱ和CIN Ⅲ共计43例．占CIN的74．1％（43／58）；CINⅡ，CINⅢ的高危型HPV阳性率分别为80．8％及94．1％。ASCUS患者中以高危型HPV检测、直接选择阴道镜检查，检出CIN的敏感度分别为88.9％和65．5%；对诊断CINⅡ和CINⅢ。高危型HPV的敏感度为94．1％，阴道镜的敏感度为65．1％。结论ASCUS患者中高危型HPV的CINⅡ和CINⅢ检出有较高的敏感度，对ASCUS可有效地进行分流监测，患者可不必再做阴道镜检查和活检。     

宫颈上皮内瘤变阴道镜下活检与电环切除术后病理的对比分析

目的 对比分析宫颈上皮内瘤变（CIN）阴道镜下活检与电环切除术后病理，提高CIN诊断的准确性。方法 回顾性对比分析216例宫颈上皮内瘤变阴道镜下活检与电环切除术后病理，探讨影响两者符合率的相关因素。结果 两者对比，宫颈电环切除术（LEEP）后病理结果与阴道镜下活检相符的74例，升级的18例，降级的124例。阴道镜下检查不满意者活检与电环切除术后病理对比，升级率大于阴道镜下检查满意者，差异有显著性（P〈0．01）。结论 宫颈转化区向宫颈管上移者，要注意宫颈管内的病变。宫颈电环切除术可以部分弥补阴道镜下活检的缺陷，且有治疗作用。     

妊娠期宫颈上皮内瘤变的监测及治疗

目的研究妊娠期宫颈上皮内瘤变（CIN）的转归,评估细胞学和阴道镜检查用于监测妊娠妇女CIN的安全性。方法对19例妊娠前通过细胞学和/或阴道镜检查诊断为CIN的妇女妊娠期间每3个月进行一次细胞学和阴道镜检查进行随访,并于产后两个月进行细胞学和阴道镜检查的再评估,必要时产后给予宫颈环形电切术（loop electrosurgical excisionp rocedure,LEEP）,如果怀疑微灶浸润,则给予局部活组织检查。结果 8例产前诊断为CINⅠ的妇女中有3例产后病变消退（37.5%）,10例产前诊断为CINⅡ～Ⅲ的妇女中有5例产后病变消退（50%）,有1例妇女发现可疑微管浸润,于妊娠期行局部活组织检查,为早期间质浸润（〈1mm）,无一例产前诊断为CINⅢ的病例产后发现微管浸润（1.5mm）。87.5%的消退病例和60%的病变稳定病例经阴道分娩（P=0.057）。结论经过妊娠有87.5%的CIN消退率,这可能归因于宫颈成熟和阴道分娩过程中发育不良宫颈上皮丢失所致,细胞学和阴道镜检查评估是安全的,局部小面积的活组织检查在可能发生的微管浸润时被推荐使用。