阴道镜下宫颈管搔刮术的诊断研究

Diagnostic study of endocervical curettage under colposcope

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.