Starzewski Józef, Góźdź Stanisław, Chil Arkadiusz, Piasek Grzegorz, Plutecki Jacek, Smorag Leszek, Dembowska Renata, Krawczyk Joanna
Swietokrzyskiego Centrum Onkologii w Kielcach.
Wiad Lek. 2003;56(3-4):162-6.
Colposcopically directed punch biopsy and endocervical curettage is considered to be a "gold standard" in diagnosing premalignant lesions of the uterine cervix. However, in daily routine practice the CIN grade, assessed on the basis of colposcopically directed punch biopsy, sometimes differs from postoperative histopathological evaluation. Such a situation can influence the methods and outcomes of further treatment of women with premalignant lesions of the uterine cervix.
The comparison of histopathological diagnoses of punch biopsies to postoperative findings.
The accuracy of punch biopsies findings was evaluated in 104 women treated in the Gynecology Ward of the District Hospital in Kielce in the years 1996-2000. Women with cytological diagnosis of LGSIL and HGSIL were included to the study. Histopathological findings of colposcopically directed punch biopsies and endocervical curettage were compared to definitive diagnoses of postoperative material obtained by conization or hysterectomy.
Discrepancies between the diagnosis of CIN grade, evaluated by colposcopically directed punch biopsies, and postoperative findings were detected in 37 cases (35.5%). Lower grade of CIN evaluated in biopsy was found in 23 cases (22.1%). Discrepancies in this group were found most often when colposcopy was unable to examine the entire lesion and positive endocervical specimen was obtained by curettage. In 12 (11.5%) cases when preoperative diagnosis showed CIN an early invasion was detected in postoperative material.
Significant discrepancies were found between pre- and post-operative evaluation of CIN grade. Therefore in each case of LGSIL diagnosed in punch biopsy HGSIL should be ruled out. Expectant management of LGSIL lesions and ablative treatment of CIN should be performed only in centers with highly qualified medical staff experienced in colposcopy and cytology. It seems to be advisable to discriminate a group threatened with fast progression into CIN III or cancer among women with LGSIL (e.g. typing of high risk HPV, aneuploidy).
阴道镜引导下的组织活检和宫颈管刮术被认为是诊断子宫颈癌前病变的“金标准”。然而，在日常临床实践中，基于阴道镜引导下组织活检评估的CIN分级有时与术后组织病理学评估结果不同。这种情况会影响子宫颈癌前病变女性进一步治疗的方法和结果。
比较组织活检的组织病理学诊断与术后结果。
对1996年至2000年在凯尔采地区医院妇科病房接受治疗的104名女性进行组织活检结果准确性评估。研究纳入细胞学诊断为低度鳞状上皮内病变（LGSIL）和高度鳞状上皮内病变（HGSIL）的女性。将阴道镜引导下组织活检和宫颈管刮术的组织病理学结果与通过锥形切除术或子宫切除术获得的术后材料的最终诊断进行比较。
在37例（35.5%）病例中检测到阴道镜引导下组织活检评估的CIN分级诊断与术后结果之间存在差异。活检中评估的CIN分级较低的情况有23例（22.1%）。该组差异最常出现在阴道镜无法检查整个病变且通过刮术获得阳性宫颈管标本时。在12例（11.5%）术前诊断为CIN的病例中，术后材料中检测到早期浸润。
CIN分级的术前和术后评估之间存在显著差异。因此，在组织活检诊断为LGSIL的每一例病例中，都应排除HGSIL。LGSIL病变的期待治疗和CIN的消融治疗仅应在拥有经验丰富的阴道镜和细胞学专业医护人员的中心进行。在LGSIL女性中区分出有快速进展为CIN III或癌症风险的群体（例如高危型人乳头瘤病毒分型、非整倍体）似乎是可取的。
