摘要
目的探讨阴道镜子宫颈活组织检查对子宫颈癌前病变诊断的准确性及子宫颈癌漏诊因素。方法选择2018年1月至2019年5月广西壮族自治区柳州市人民医院就诊的327例患者,所有患者均行阴道镜活组织检查,且组织学诊断为子宫颈上皮内瘤变(CIN)Ⅰ、CINⅡ、CINⅢ、慢性子宫颈炎、子宫颈原位癌、扁平湿疣或湿疣样改变,行子宫颈环形电切术(LEEP)治疗并进行术后病理检查。比较子宫颈阴道镜活组织检查与LEEP术后病理检查结果,并对阴道镜子宫颈活组织检查中子宫颈癌漏诊影响因素进行单因素及多因素分析。结果阴道镜下子宫颈活组织检查对慢性子宫颈炎诊断准确率为59.70%(40/67),对扁平湿疣或湿疣样改变诊断准确率为51.58%(49/95),对CINⅠ诊断准确率为85.14%(63/74),对CINⅡ、CINⅢ及子宫颈原位癌诊断准确率为73.63%(67/91),与LEEP术后病理结果相符患者共计219例,总体诊断准确率为66.97%(219/327);术后病理提示诊断不足患者43例(13.15%),诊断过度患者48例(14.68%)。多因素logistic回归分析结果显示,子宫颈病变占子宫颈面积<50%、阴道镜图像质量不满意以及患者年龄≥50岁是子宫颈癌漏诊的独立影响因素(均P<0.05)。结论阴道镜下子宫颈活组织检查对子宫颈癌前病变诊断准确性不高,易发生子宫颈癌漏诊,应提高阴道镜操作技能,同时关注老年女性及阴道镜图像不满意患者的检查,以进一步降低子宫颈癌漏诊率。
Objective To investigate the accuracy of colposcopic cervical biopsy in the diagnosis of cervical precancerous lesions and the factors of missed diagnosis of cervical cancer.Methods A total of 327 cases of gynecological clinic in Liuzhou people's Hospital of Guangxi Zhuang Autonomous Region from January 2018 to May 2019 were selected.All patients underwent colposcopic biopsy and were histologically diagnosed as cervical intraepithelial neoplasia(CIN)Ⅰ,CINⅡ,CINⅢ,chronic cervicitis,cervical carcinoma in situ,and condyloma plana or condyloma-like change.The loop electrosurgical excision procedure(LEEP)was performed for treatment and pathological examination after operation was done.The results of pathological examination after colposcopic cervical biopsy and LEEP operation were compared.Univariate and multivariate logistic regression analysis was performed on the factors affecting missed diagnosis of cervical cancer by colposcopic cervical biopsy.Results The diagnostic accuracy of colposcopic cervical biopsy for chronic cervicitis was 59.70%(40/67),for condyloma plana or condyloma-like lesions was 51.58%(49/95),for CINⅠdiagnosis was 85.14%(63/74),for CINⅠ,CINⅢand carcinoma in situ was 73.63%(67/91).A total of 219 patients were consistent with the postoperative pathological results of LEEP,and the total diagnostic accuracy rate was 66.97%(219/327).The postoperative pathological results showed that there were 43 patients(13.15%)with acatalepsia and 48 patients(14.68%)with excessive diagnosis.The results of multivariate logistic regression analysis showed that the area of cervical lesions<50%of the cervix area,unsatisfactory colposcopy image quality,and the patient's age≥50 years old were independent influencing factors for missed diagnosis of cervical cancer(all P<0.05).Conclusions Cervical biopsy under colposcopy has a certain inaccuracy in the diagnosis of cervical precancerous lesions,and it is prone to missed diagnosis of cervical cancer.Clinicians should improve the skills of colposcopy operation,and pay attention to the examination of elderly women and patients with unsatisfactory colposcopy images in order to further reduce the missed diagnosis rate of cervical cancer.
作者
陈静
陈煜岊
弋文娟
Chen Jing;Chen Yujie;Yi Wenjuan(Department of Gynecology,Liuzhou People's Hospital,Guangxi Zhuang Autonomous Region,Liuzhou 545006,China)
出处
《肿瘤研究与临床》
CAS
2020年第8期579-583,共5页
Cancer Research and Clinic
关键词
宫颈肿瘤
阴道镜检查
诊断
癌前病变
漏诊
Uterine cervical neoplasms
Colposcopy
Diagnosis
Precancerous lesions
Missed diagnosis
