宫颈CIN病变特点及不同病理学检查的价值探讨

目的探讨宫颈CIN病变特点及细胞学检查和阴道镜下点活检在其诊断中的价值。方法分析1033例CIN以上病变的阴道镜下多点活检的病变特点及1112例细胞学阳性病例的活检对照,数据采用χ2检验。结果1033例病理诊断CIN以上病变CINⅠ级508例,71例见挖空细胞提示合并湿疣病变,60例累及浅层腺体,累腺率为11.8%（60/508）,平均累犯点数1.45（737/508）;CINⅡ级325例,其中119例合并存在CINⅠ,17例合并存在湿疣病变,共有133例累及浅层腺体;累腺率40.9%（133/325）,平均累犯点数1.95（634/325）;CINⅢ级162例,合并存在CINⅡ91例、CINⅠ21例、湿疣样病变7例,累及腺体93例,累腺率57.4%;平均累犯点数2.68（434/162）;宫颈癌38例,包括浸润癌19例,疑似浸润癌19例,累腺28例,累腺率73.6%,总计累犯点位数142,平均累犯点位数3.74。1112例细胞学阳性病例ASC-US/ASG-US,LSIL,ASC-H,HSIL与病理的符合率依次为50.1%、72.8%、70.7%、91.3%。结论宫颈CIN病变特点是多点发生,不同级别病变同时存在,随着病变的级别增加病变范围逐渐扩大（深度和广度）,随着病变级别的增加细胞学检查与组织活检的符合率也逐渐增高。细胞学检查是初筛的理想手段,确诊需要阴道镜活检,但点活检信息不全易导致早期浸润癌漏诊,不同的病理检测结果应该相互参照。

Pathologic features of cervical intraepithelial neoplasia and evaluation of cytology and colposcopy biopsy in diagnosis of CIN

Objective To study the pathologic features of cervical intraepithelial neoplasia（CIN） and evaluate the utility of cervical cytological test and colposcopy local biopsy in the diagnosis of CIN. Methods The pathologic features of colposcopy multiple biopsy in 1033 cases of CIN were analyzed. 1112 patients with positive cytological examination were selected as control. Chi square test was used to analyze the data. Results Among 1033 cases of CIN by pathological diagnosis,there were 508 cases of CIN I,included 71 cases with cervical condylomas by the recognition of koilocytes,the superficial glands were involved in 60 cases with a rate of 11. 8%（60 /508）,the average involved sites in glandular were 1. 45（737/508）;325 cases of CIN II,in which 119 cases were with the presence of CIN I,17 cases were with condyloma lesions,the superficial glands were involved in 113 cases with a rate of 40. 9%（133 /325）,the average involved sites in glandular were 1. 95（634 /325）;162 cases of CIN Ⅲ,in which 91 cases were with the presence of CIN II,21 cases with the presence of CIN I,and 7 cases were with condyloma lesions,the superficial glands were involved in 93 cases with a rate of 57. 4%,the average involved sites in glandular were 2. 68（434 /162）;38 cases of cervical cancer,included 19 cases of invasive carcinoma,19 cases of suspected invasive cancer,the glands were involved in 28 cases with a rate of73. 6%,the overall involved sites in glandular were 142,and the average involved sites in glandular were 3. 74. In 1112 cases with positive cytological tests,the coincidence rate of ASC-US /ASG-US,ASC-H,LSIL and HSIL with pathological diagnosis was 50. 1%,70. 7%,72. 8% and 91. 3%,respectively. Conclusion The characteristics of cervical lesions of CIN is multi-site lesion,and different grade of lesions can be found at the same time;the area of lesions should expand with lesions levels（width and depth）. The coincidence rate of cytology and biopsy also increased with the grade of lesions.Cytological examinati