摘要
目的探讨宫颈高度鳞状上皮内病变及宫颈癌患者阴道镜印象与活检组织病理诊断升级情况及分析相关因素。方法选择门诊行阴道镜检查并行宫颈活检和(或)宫颈管搔刮术诊断为高度鳞状上皮内病变(HSIL)及癌(HSIL^+)的患者共320例。收集所有患者的液基细胞学检查(LCT)、高危型HPV(HR-HPV)检测、阴道镜检查及其活检组织病理检查结果,分析阴道镜印象与宫颈活检组织病理学诊断的符合情况,以及影响阴道镜印象的相关因素。结果 320例HSIL^+患者中HR-HPV阳性率为97.2%(311/320),细胞学阳性率为73.1%(234/320),HR-HPV阳性率显著高于细胞学阳性率(χ~2=73.29,P<0.001);宫颈活检组织病理诊断较阴道镜印象升级者102例,占31.88%(102/320)。组织病理学诊断升级的单因素分析显示,LCT检查结果为未见上皮内病变细胞或恶性细胞(NILM)、不能明确意义的非典型鳞状细胞(ASCUS)、低度鳞状上皮内病变(LSIL)较非典型鳞状细胞-不能除外高度鳞状上皮内病变(ASC-H)/高度鳞状上皮内病变(HSIL)/非典型腺细胞(AGC)组织病理诊断升级率高(分别为53.5%、42.9%、37.1%及11.8%,χ~2=47.78,P=0.001);HR-HPV型别中16/18型阳性较52/58型阳性、其他型别阳性/HPV阴性的组织病理诊断升级率低(分别为23.0%、47.7%、38.3%,χ~2=13.1,P=0.003);年龄(<50岁或≥50岁)、宫颈手术史、转化区类型与组织病理诊断升级无显著相关性。结论宫颈细胞学筛查结果可能影响操作者对阴道镜印象的评判,细胞学筛查联合HR-HPV检测可明显提高宫颈病变筛查的敏感度,减少宫颈高级别病变的漏诊。HR-HPV分型、转化区类型与宫颈活检组织病理学诊断升级相关,基于风险分层的阴道镜检查及多点活检、宫颈管搔刮术可弥补阴道镜检查敏感性较低的问题。
Objective To investigate the correlation between colposcopic impression and the pathologic upgrade of biopsies in cervical high squamous intraepithelial lesions and cervical cancer. Methods A total of 320 cases of cervical high squamous intraepithelial lesions(HSIL) and cervical cancer(HSIL^+) diagnosed with colposcopy and biopsy were included. The results of liquid-based cytology test(LCT), high-risk HPV(HR-HPV), colposcopy and biopsy were collected. The concordance between colposcopic impression and biopsy was analyzed, as well as the factors affected colposcopy. Results In 320 HSIL^+ patients, the positive rate of HR-HPV was significantly higher than cytology results(97.2% vs. 73.1%, χ~2=73.29, P<0.001).Univariate analysis showed that the pathologic upgrade rates were significantly higher for NILM, ASCUS and LSIL than that of ASC-H/HSIL/AGC(53.5%, 42.9%, 37.1% and 11.8%, χ~2=47.78, P=0.001);the pathologic upgrade rate was significantly lower in HPV 16/18 positive cases than those of HPV 52/58 and other types positive cases(P=0.003). There was no significant correlation between age, history of cervical surgery, type of transformation zone and pathologic diagnosis. Conclusion Colposcopic impression may be affected by the results of cervical cytology screening. Cytology combined with HR-HPV screenings can significantly improve the sensitivity of cervical cancer screening and reduce the missed of high-level cervical lesions. HR-HPV type and the type of transformation zone are correlated to the pathologic upgrading of cervical biopsy. Colposcopy, multi-point biopsy and cervical curettage based on risk stratification can compensate the low sensitivity of colposcopy.
作者
蔡如玉
欧阳程欣
王莉菲
张立杰
CAI Ru-yu;OUYANG Cheng-xin;WANG Li-fei;ZHANG Li-jie(Department of Gynecology,Shenzhen People's Hospital,Second Clinical Medical College of Jinan University,Shenzhen 518020,Guangdong,China)
出处
《广东医学》
CAS
2020年第10期1037-1040,共4页
Guangdong Medical Journal
