摘要
目的探讨阴道镜下多点活检联合宫颈管搔刮术(ECC)在绝经后宫颈病变诊断中的临床价值。方法选取2015年3月至2017年3月在首都医科大学附属北京妇产医院妇瘤科门诊就诊的因宫颈细胞学和(或)人乳头状瘤病毒检查异常,需要行阴道镜检查,并因病情需要行宫颈锥切术的204例宫颈病变患者作为研究对象,依据是否绝经分为绝经前组和绝经后组,各102例。以宫颈锥切术(宫颈环切术或冷刀锥切术)后病理结果作为标准,分析阴道镜下多点活检联合ECC病理诊断的一致性。结果绝经后组阴道镜下多点活检及其联合ECC的病理诊断与宫颈锥切术后病理诊断的一致率(Kappa值)分别为71. 57%(0. 586)、88.24%(0. 826),而绝经前组阴道镜下多点活检及其联合ECC的病理诊断与宫颈锥切术后病理诊断的一致率(Kappa值)分别为84. 31%(0. 757)、95. 10%(0. 922),绝经后组和绝经前组阴道镜下多点活检联合ECC诊断宫颈病变[宫颈上皮内瘤变(CIN)和宫颈癌]的一致率(Kappa值)分别较单纯阴道镜下多点活检提高16.67%和10. 79%;且阴道镜下多点活检联合ECC诊断宫颈病变(CIN和宫颈癌)的灵敏度、特异度、阳性预测值、诊断符合率和Kappa值均较单独阴道镜下多点活检高,对绝经后宫颈病变(CIN和宫颈癌)患者的检测效能较未绝经患者高(P <0. 01)。结论阴道镜下多点活检联合ECC诊断绝经后CIN和宫颈癌的准确率较高,与宫颈锥切术后病理诊断的一致性较高,在绝经后CIN和宫颈癌诊断方面具有较高的临床应用价值。
Objective To evaluate the clinical value of multipoint colposcopy biopsy combined with endocervical curettage( ECC) in the diagnosis of cervical lesions in postmenopausal women. Methods From Mar. 2015 to Mar.2017,204 female patients admitted to the Department of Gynecologic Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University for abnormal cervical cytology and/or human papillomavirus,who needed colposcopy examination,and cervical cone resection due to their conditions were included in the study. Among them,102 cases were premenopausal and 102 cases were postmenopausal. Based on the pathological results of loop electrosurgical excisionprocedure or cold knife conization after cone resection,the diagnostic consistency of multi-point biopsy under colposcopy combined with ECC was analyzed. Results The consistent rate of colposcopic multi-point biopsy and combined with ECC to that of cervical conization was 71. 57%( 0. 586) and 88. 24%( 0. 826) respectively in the postmenopausal group,while the consistent rate of colposcopic multi-point biopsy and combined with ECC to that of cervical conization was 84. 31%( 0. 757) and 95. 10%( 0. 922) respectively in the premenopausal group. The Kappa value of colposcopy combined with ECC increased by 16. 67% and 10. 79% than that of colposcopy alone respectively in the two groups;the sensitivity,specificity,positive predictive value,diagnosis consistency rate,Kappa value of colposcopy combined with ECC of cervical intraepithelial lesion( CIN and cervical cancer) were higher than those of colposcopy alone,and the detection efficiency in the postmenopausal patients was higher than that in the premenopausal patients( P < 0. 01). Conclusion The accuracy of multi-point colposcopy combined with ECC in the diagnosis of CIN and cervical cancer in postmenopausal women is high,which has higher consistency rate with the pathological diagnosis after cervical conization,so it has a higher clinical value in the diagnosis of CIN and cervical cancer in postmenopausal women.
作者
李艳梅
王建东
宋金维
LI Yanmei;WANG Jiandong;SONG Jinwei(Department of Gynecologic Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100010,China;Department of Gynecology,Beijing You′an Hospital,Capital Medical University,Beijing 100069,China;Department of Gynecology,Beijing Xicheng District Maternal and Child Health Care Hospital,Beijing 100054,China)
出处
《医学综述》
2020年第4期809-814,共6页
Medical Recapitulate
基金
北京市科技计划课题(Z171100000417027)。
关键词
宫颈病变
宫颈上皮内瘤变
宫颈癌
阴道镜下多点活检
宫颈管搔刮术
绝经后
绝经前
Cervical lesion
Cervical intraepithelial neoplasia
Cervical cancer
Multi-point biopsy under colposcopy
Endocervical curettage
Postmenopause
Premenopause
作者简介
通信作者:王建东,Email:wangjiandongxy@hotmail.com。
