阴道镜表现与宫颈上皮内瘤变进展的关系及对高级别病变评估漏诊的因素分析

Study on the relationship between colposcopy findings and the progression of cervical intraepithelial neoplasia and the analysis of missed diagnosis factors in the evaluation of high-grade lesions

摘要:

目的 探讨阴道镜表现与宫颈上皮内瘤变（CIN）进展的关系及对高级别病变评估漏诊的因素。方法 选取2020年1月－2023年11月于该院行阴道镜下活检且存在CIN的患者304例。根据阴道镜活检结果，将CIN分为CIN Ⅰ级（103例）、CIN Ⅱ级（137例）、CIN Ⅲ级（59例）及早期浸润癌（5例）。通过对比宫颈环形电切术（LEEP of cervix）术后病理结果，将高级别病例（CIN Ⅱ级及以上）进一步分为检出组和漏诊组。采用Logistic回归模型，分析影响阴道镜漏诊高级别CIN的危险因素。结果 阴道镜下异常血管和醋酸白上皮的表现有助于区分不同级别CIN；阴道镜活检对于CIN的诊断符合率较高，但仍有21例高级别CIN漏诊（CIN Ⅱ级14例，CIN Ⅲ级5例，早期浸润癌2例）。分娩、绝经、碘不着色区 < 2 cm、细胞学检查为低级别磷状上皮内病变（LSIL）、宫颈病变面积 < 1/2、活检标本为1个和阴道镜图像模糊是影响阴道镜检查漏诊高级别CIN的独立危险因素（P < 0.05）。结论 阴道镜活检对不同级别CIN病例的诊断符合率均较高。分娩、绝经、碘不着色区 < 2 cm、细胞学检查为LSIL、宫颈病变面积 < 1/2、活检标本为1个和阴道镜图像模糊是影响阴道镜检查漏诊高级别CIN的独立危险因素。

Abstract:

Objective To investigate the relationship between colposcopy findings and the progression of cervical intraepithelial neoplasia (CIN) and analyze the factors of missed diagnosis in the evaluation of high-grade lesions.Methods 304 cases who underwent colposcopy-guided biopsy and were diagnosed with CIN from January 2020 to November 2023 were selected. Based on colposcopic biopsy results, patients were classified into CIN I (103 cases), CIN II (137 cases), CIN III (59 cases), and early invasive carcinoma (5 cases). By comparing with postoperative pathological results from loop electrosurgical excision procedure of cervix (LEEP of cervix) , high-grade cases (CIN II and above) were further subdivided into the detected group and the missed diagnosis group. Logistic regression analysis was performed to identify factors influencing the underdiagnosis of high-grade CIN by colposcopy.Results Abnormal blood vessels and acetowhite epithelium observed during colposcopy were helpful in differentiating various grades of CIN. Although the overall concordance rate of CIN diagnosis by colposcopy-guided biopsy was relatively high, 21 cases of high-grade CIN (including 14 CIN II, 5 CIN III, and 2 early invasive carcinoma) were missed. Factors independently associated with the underdiagnosis of high-grade CIN included parity, menopause, non-staining areas with iodine < 2 cm, cytological examination of low-grade squamous intraepithelial lesion (LSIL), lesion size < 1/2, single biopsy specimen, and poor-quality colposcopic images (P < 0.05).Conclusion Colposcopic biopsy shows a high concordance rate for diagnosing CIN across different grades. However, parity, menopause, non-staining areas with iodine < 2 cm, cytological examination of LSIL, lesion size < 1/2, single biopsy specimen, and colposcopic image poor-quality are identified as independent factors influencing the underdiagnosis of high-grade CIN. These factors should be considered in clinical practice to improve diagnostic accuracy.