阴道镜在诊断宫颈癌前期病变中的价值

目的　分析CIN患者阴道镜诊断、阴道镜下定点活检组织学诊断及手术后病理诊断符合情况 ,探讨阴道镜诊断宫颈上皮内瘤变 (CIN)的相关影响因素。方法　回顾性分析经病理检查确诊的 195例CIN患者 ,有 44例接受宫颈物理治疗 (电熨或激光 )。接受宫颈锥切 2 6例 ,占 13 .3 % ,经腹部手术的 2 5例 ,占 12 .8% ,术中行冰冻切片病理检查 13例。结果　阴道镜诊断的准确率为 94.4% ,镜下活检的准确率为 98.5 %。冰冻切片诊断符合率为 5 3 .8% ( 7/ 13 )。阴道镜误诊组患者阴道镜检查的时间、宫颈活检数量与阴道镜诊断符合组患者比较 ,无显著性差异 (P >0 .0 5 )。误诊组已绝经的患者较多。结论　阴道镜诊断的准确性与阴道镜检查的时间、阴道镜下活检的数量、术前CIN分级无显著差异。阴道镜下活检不能代替锥切 ,CIN患者手术中冰冻切片检查仍不能完全避免误诊。

Value of colposcopy in the diagnosis of early pathological changes of cervical intraepithelial neoplasia

Objective To compare the results of colposcopy and histological diagnosis with those of pathological diagnosis after operation on patients with cervical intraepithelial neoplasia (CIN) and to evaluate the related influencing factors of colposcopy in the diagnosis of CIN. Methods The data of 195 patients with CIN confirmed pathologically were retrospectively analyzed. In these 195 cases, 44 patients received physiotherapy(electrocoagulation and laser) and 26(13.3%) and 25(12.8%) patients underwent cervical conization and hysterectomy, respectively. Pathological examination of the cervices was performed on 13 patients during operation. Results The accurate rates of colposcopy and histological examination with colposcopic biopsy were 94.4% and 98.5%, respectively. However, the accurate rate of biopsy was 53.8%(7/13). There was no significant difference in the time for colposcopy, and the quantity of cervical biopsies between misdiagnosed CIN patients and finally diagnosed CIN patients ( P >0.05). There were more menopausal cases in misdiagnosed patients. Conclusion The accurate rate of colposcopy is not significantly correlated with the time for colposcopy, the quantity of cervical biopsies and the preoperative grading of CIN. Histological diagnosis with colposcopic biopsy can not be used for the replacement of cervical conization. Misdiagnosis of patients with CIN can not be avoided by biopsy during operation.