阴道镜诊断CIN的准确性及漏诊宫颈癌的相关因素分析

Accuracy of colposcopy in the diagnosis of CIN and factors associated with missed diagnosis of cervical cancer

关键词:  阴道镜；宫颈上皮内瘤变  漏诊

Key words:  colposcopy  cervical intraepithelial neoplasia  missed diagnosis

摘要:

目的　评价阴道镜活检诊断宫颈鳞状上皮内瘤变(CIN)的准确性及漏诊宫颈癌的相关因素分析。方法　回顾性收集2012年6月至2018年12月在大连市中心医院妇科门诊行阴道镜活检诊断为CIN，同时行手术治疗的80例患者的临床病理资料。以术后病理诊断为金标准，计算阴道镜下宫颈活检诊断CIN的准确率。单因素分析漏诊宫颈癌的相关因素。结果　80例患者阴道镜下活检与术后病理检查符合率57.5％；术后提示病理升级者15例，占18.75％，其中漏诊宫颈癌10例，漏诊率12.5%；术后提示病理降级者19例，占23.75％。阴道镜诊断与术后病理诊断的一致性一般（Kappa=0.42，P=0.065）。单因素分析显示：未行宫颈管搔刮（ECC）是漏诊宫颈癌的独立危险因素(P<0.05)；不同年龄、TCT或DNA结果、有无高危HPV感染、宫颈病变面积、阴道镜转化区、是否累及腺体，在比较是否漏诊宫颈癌方面差异无统计学意义(P>0.05)。结论　阴道镜对宫颈病变具有直观性，但存在漏诊宫颈微小浸润癌的风险，ECC是降低宫颈癌漏诊率的关键。

Abstract:

Objective　To evaluate the accuracy of colposcopic biopsy in the diagnosis of cervical squamous intraepithelial neoplasm (CIN) and to analyze the related factors of missed diagnosis of cervical cancer. 　Methods　The clinical and pathological data of 80 patients with CIN diagnosed by colposcopic biopsy from June 2012 to December 2018 were retrospectively reviewed. The accuracy of CIN diagnosis by cervical biopsy under colposcopy was calculated according to the gold standard of pathological diagnosis after operation. The related factors of missed diagnosis of cervical cancer were analyzed by univariate analysis. 　Results　 The consistency rate of colposcopic biopsy pathology and post-operative pathology was 57.5% in 80 patients. Higher grade lesions were suggested within post-operative pathology in 15 cases (18.75%), including 10 cases of missed cervical cancer (missed diagnosis rate 12.5%). Lower grade lesions were suggested within post-operative pathology in 19 cases (23.75%). The consistency between colposcopic diagnosis and pathological diagnosis was in the average range (Kappa=0.42, P=0.065). Univariate analysis revealed that lacking endocervical curettage (ECC) was an independent risk factor for missed diagnosis of cervical cancer (P<0.05). There were no significant differences in age, TCT or DNA results, presence or absence of high-risk HPV infection, area of cervical lesions, colposcopic transformation area and involvement of glands in comparison of missed diagnosis of cervical cancer (P>0.05). 　Conclusion　Colposcopy is intuitive for cervical lesions, but there is a risk of missed diagnosis of minimally invasive cervical cancer. ECC is the key to reduce the rate of missed diagnosis of cervical cancer.