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目的评价阴道镜引导宫颈活检(colposcopically directed biopsy,CDB)诊断宫颈病变的优势与不足。方法收集2006年1月～2010年12月合肥市第二人民医院妇科门诊患者中,行宫颈LEEP术前均行CDB的95例患者临床资料,分析比较CDB和LEEP术后的病理检查结果。结果阴道镜下多点活检和宫颈LEEP术后病理结果的符合率为87.4%。宫颈LEEP术后病理降级或为慢性宫颈炎的有28例,占29.5%;CDB和LEEP病理组织学诊断完全相符有55例,占57.9%;宫颈LEEP术后病理升级的有12例,占12.6%,其中CINⅡ有8例,占8.4%,CINⅢ级以上有4例,占4.2%,其中包括1例原位癌,1例浸润癌,CDB诊断高级别CIN的阴性预测值77.1%。结论 CDB可以发现大部分宫颈病变患者。CDB诊断为高级别宫颈病变时,不能排除宫颈浸润癌。LEEP可弥补CDB的不足,提高宫颈疾病诊断的准确性。
Objective To evaluate the advantages and disadvantages of colposcopically directed biopsy (CDB) in the diagnosis of cervical lesions. Methods The clinical data of 95 patients with CDB who underwent cervical LEEP from January 2006 to December 2010 in gynecology outpatient department of Hefei Second People’s Hospital were collected for pathological examination after CDB and LEEP. Results The colposcopy coincidence rate of colposcopy biopsy and cervical LEEP was 87.4%. Cervical LEEP pathological degradation or chronic cervicitis in 28 cases, accounting for 29.5%; CDB and LEEP histopathological diagnosis completely consistent with 55 cases, accounting for 57.9%; cervical LEEP pathological upgrade in 12 cases, accounting for 12.6 Among them, 8 cases were CINⅡ, accounting for 8.4%, 4 cases were CINⅢ, accounting for 4.2%, including 1 case of carcinoma in situ and 1 case of invasive carcinoma. The negative predictive value of CDB in diagnosis of high grade CIN was 77.1%. Conclusion CDB can be found in most patients with cervical lesions. Cervix invasive carcinoma can not be ruled out when CDB is diagnosed with high-grade cervical lesions. LEEP can make up for the lack of CDB, improve the accuracy of cervical disease diagnosis.