阴道镜下宫颈管搔刮术的诊断研究
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广东省妇幼保健院 体检科,广东 广州 510010

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余凡,E-mail:yufan1128www@163.com

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广东省医学科学技术研究基金项目(No:C2020033)


Diagnostic study of endocervical curettage under colposcope
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Department of Physical Examination, Guangdong Women and Children Hospital, Guangzhou, Guangdong 510010, China

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    摘要:

    目的 探讨阴道镜下宫颈管搔刮术(ECC)的诊断价值。方法 选取门诊机会性筛查的女性2 095名,均行宫颈液基薄层细胞学检查(TCT)联合人乳头瘤病毒(HPV)筛查、阴道镜下多点活检及ECC取样,分析ECC的诊断价值。结果 ECC总阳性率为6.8%(142/2 095),ECC对高级别鳞状上皮内病变(HSIL)以上病变(HSIL+)的诊断敏感性为30.3%(95%CI:26.20~34.80),ECC对HSIL+的额外检出率为4.5%(21/468)。二元Logistic回归分析发现,年龄(OR^ = 1.04,95%CI:1.02~1.06)、细胞学明显异常[不排除高级别鳞状上皮内病变的非典型鳞状细胞(ASC-H)/HSIL+](OR^ = 16.65,95%CI:10.19~27.19)、转化区的可见性(OR^ = 4.35,95%CI:2.71~6.97)和高危型人乳头瘤病毒(hrHPV)感染(OR^ = 7.55,95%CI:2.72~20.98)是影响ECC对HSIL+检出率的危险因素。细胞学为非典型鳞状上皮细胞意义不明确(ASCUS)或低级别鳞状上皮内病变(LSIL)者,ECC对HSIL+的额外诊断价值极低,仅为0.6%(6/941)。在各年龄组中,细胞学为ASC-H/HSIL+、30岁以上且有HPV16/18感染者,ECC对HSIL+的诊断价值较高(11.0%~44.4%)。结论 阴道镜下ECC在细胞学ASC-H/HSIL+,或年龄≥30岁且有HPV16/18感染的女性中具有较高的诊断价值,而对于细胞学轻微异常者,其额外诊断价值低。

    Abstract:

    Objective To explore the diagnostic value of endocervical curettage under colposcope (ECC).Methods 2 095 women with opportunistic screening were selected and all underwent cervical liquid based thin layer cytology (TCT) combined with human papillomavirus (HPV) screening, colposcopy multi-point biopsy and ECC sampling to analyze the diagnostic value of ECC.Results The total positive rate of ECC was 6.8% (142/2 095), the diagnostic sensitivity of high-grade squamous intraepithelial lesions (HSIL+) was 30.3% (95%CI: 26.20~34.80), and the additional positive rate of ECC for HSIL+ was 4.5% (21/468). Binary Logistic regression analysis showed that age (OR^ = 1.04, 95%CI:1.02 ~ 1.06), obvious cytological abnormality [atypical squamous cells: cannot exclude high-grade squamous intraepithelial lesion (ASC-H)/HSIL+] (OR^ = 16.65, 95%CI:10.19 ~ 27.19), visibility of transformation region (OR^ = 4.35, 95%CI: 2.71 ~ 6.97) and high-risk human papillomavirus (hrHPV) infection (OR^ = 7.55, 95%CI: 2.72 ~ 20.98) were risk factors affecting the positive detection rate of HSIL+ by ECC. For patients with atypical squamous epithelial cells of undertermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL), the additional diagnostic value of ECC for HSIL+ was very low, only 0.6% (6/941). The diagnostic value of ECC for HSIL+ was higher in patients with ASC-H/HSIL+ cytology and over 30 years old with HPV16/18 infection (11.0% ~ 44.4%).Conclusion Colposcopic ECC has a high diagnostic value in women with ASC-H/HSIL+ cytology, or age ≥ 30 years old and HPV16/18 infection, but it has a low additional diagnostic value in women with slight cytological abnormalities.

    表 2 ECC病理特点及影响因素分析Table 2 Pathological characteristics of ECC and analysis of influence factors
    表 1 宫颈活检及ECC的病理诊断结果 例Table 1 Pathological diagnostic result of ectocervical biopsy and ECC n
    图 不同年龄亚组、不同细胞学及HPV感染状态下ECC对HSIL+的诊断率Fig.
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王意,曾俐琴,张秀,李秀莹,罗喜平,余凡.阴道镜下宫颈管搔刮术的诊断研究[J].中国内镜杂志,2022,28(7):1-6

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  • 收稿日期:2021-07-26
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  • 在线发布日期: 2022-08-12
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