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目的评价阴道镜直视下活检诊断宫颈上皮内瘤变(CIN)的准确性和全面性。方法回顾性分析2006年1月～2008年5月阴道镜下活检诊断为CIN,并于短期内行宫颈环形电切术(LEEP)的160例患者的临床病理资料,采用自身对照对比研究阴道镜下活检和最终病理结果,并分析阴道镜直视下宫颈活检漏诊浸润性宫颈癌的相关因素。结果160例患者阴道镜下宫颈活检病理诊断同最终诊断符合者111例(69.4%),不符合者49例(30.6%),其中诊断过度者为14.3%(23/160),诊断不足者为16.2%(26/160)。160例患者最终诊断为宫颈浸润癌18例,漏诊率为11.3%。细胞学检查结果为HSIL及以上病变者,病灶累及腺体和多个病灶级别并存同阴道镜下宫颈活检浸润癌的漏诊发生显著相关(P均<0.05)。结论阴道镜直视下活检对确诊CIN尚不够可靠,存在着宫颈浸润癌漏诊的可能。阴道镜活检病理诊断为CINⅠ者应根据阴道镜检查图象满意度、随访可行性、患者年龄、生育要求等因素综合分析来决定进一步诊疗方案,必要时可行宫颈LEEP锥切或局部切除。
Objective To evaluate the accuracy and comprehensiveness of biopsy in the diagnosis of cervical intraepithelial neoplasia (CIN) under colposcopy. Methods The clinical data of 160 patients with CIN diagnosed by colposcopy biopsy from January 2006 to May 2008 were analyzed retrospectively. Collected by self-control and colposcopy Biopsy and final pathology results, and analyze the related factors of missed diagnosis of invasive cervical cancer under cervical biopsy under colposcopy. Results The colposcopic biopsy results of colposcopy in 111 cases (69.4%) and 49 cases (30.6%) did not coincide with the final diagnosis, of which 14.3% (23/160) were diagnosed as undiagnosed 16.2% (26/160). The final diagnosis of 160 cases of cervical invasive carcinoma in 18 cases, the missed diagnosis rate was 11.3%. Cytological examination of HSIL and above lesions, lesions involving the gland and multiple lesion coexistence with colposcopic cervical biopsy invasive carcinoma of the missed diagnosis (P all <0.05). Conclusion colposcopy biopsy is not reliable enough to confirm the diagnosis of CIN, there is the possibility of missed diagnosis of cervical cancer. Colposcopic biopsy pathological diagnosis of CIN Ⅰ should be based on colposcopy image satisfaction, follow-up feasibility, patient age, reproductive requirements and other factors to determine a comprehensive analysis of the treatment plan, if necessary, feasible LEEP conization or local excision.