液基薄层细胞学、活检病理和宫颈环形电切术(LEEP)诊断早期宫颈癌及宫颈上皮细胞内瘤样病变的比较研究

目的:比较细胞学、活检病理和宫颈环形电切术(loop electrosurgical excisional procedure,LEEP)病理诊断早期宫颈癌和宫颈上皮细胞内瘤样病变(cervicalintraepithelialneoplasia,CIN)的准确性。方法:回顾性比较分析201例进行LEEP患者术后病理、术前活检病理和液基薄层细胞学(thinprep cytologic test,TCT)3种诊断方法的检测结果。结果:201例LEEP术后组织病理分析显示92例(45.8%)患者具有CIN2~3病变及4例浸润癌患者,其中71例患者术前病理为CIN2及以上鳞状上皮内瘤样病变。在细胞学检查结果为LSIL的66例患者中活检病理和LEEP病理结果为CIN2及以上病变的分别有22例和23例。活检病理与LEEP病理符合率为86.5%,Kappa值为0.718。活检病理结果为CIN1的113例患者中有16例LEEP病理结果为CIN2及以上病变。结论:活检病理可以提高细胞学结果为LSIL的患者中宫颈高级别病变的诊断效率,对确定合理的LEEP术前指征具有重要的临床价值。

Comparison of Liquid Based Cytology,Biopsy,and Loop Electrosurgical Excisional Procedure(LEEP) for Diagnosis of Cervical Cancer and Cervical Intraepithelial Neoplasia

Objective: To compare liquid based cytology,biopsy,and loop electrosurgical excisional procedure(LEEP) histopathology for diagnosis of cervical cancer and cervical intraepithelial neoplasia(CIN).Methods: A total of 201 patients who referred for LEEP were enrolled in this study.The diagnostic results of thinprep cytologic tests(TCT),previous biopsies,and LEEP pathology were compared and evaluated.Results: In LEEP pathology of 201 patients,92 cases(45.8%) were identified to have CIN2 or above lesion,and 4 cases were confirmed as invasive cancer.Among them,71(71/92) biopsy was CIN2 or above cervical lesions.Biopsy and LEEP determined 22 and 23 CIN2 or above cases in 66 LSIL cases by TCT,respectively.The concordance rate of biopsy and LEEP was 86.5%,and the Kappa value was 0.718.Among 113 CIN1 patients conformed by biopsy,LEEP pathology found 16 cases of CIN2 or above.Conclusion: Biopsy may improve the diagnosis of CIN2 or above cervical lesions in LSIL patients by TCT,and will be helpful for determination of index for LEEP in clinical practice.