阴道镜引导下活检、随机宫颈活检及宫颈管刮除术在诊断宫颈上皮内瘤变II级或更严重病变中的应用
Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse.
作者信息
Pretorius Robert G, Zhang Wen-Hua, Belinson Jerome L, Huang Man-Ni, Wu Ling-Ying, Zhang Xun, Qiao You-Lin
机构信息
Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Fontana, CA, USA.
出版信息
Am J Obstet Gynecol. 2004 Aug;191(2):430-4. doi: 10.1016/j.ajog.2004.02.065.
OBJECTIVES
The purpose of this study was to determine the relative importance of colposcopically directed biopsy, random biopsy, and endocervical curettage (ECC) in diagnosing > or =cervical intraepithelial neoplasia (CIN) II. Study design During a screening study, 364 women with satisfactory colposcopy and > or =CIN II were diagnosed. All colposcopically detected lesions were biopsied. If colposcopy showed no lesion in a cervical quadrant, a random biopsy was obtained at the squamocolumnar junction in that quadrant. ECC was then performed.
RESULTS
The diagnosis of > or =CIN II was made on a colposcopically directed biopsy in 57.1%, random biopsy in 37.4%, and ECC in 5.5% of women. The yield of > or =CIN II for random biopsy when cytology was high grade (17.6%) exceeded that when cytology was low grade (2.8%). One of 20 women diagnosed solely by ECC had invasive cancer.
CONCLUSION
Even when colposcopy is satisfactory, ECC should be performed. If cytology is high grade, random biopsies should be considered.
目的
本研究的目的是确定阴道镜引导下活检、随机活检和宫颈管搔刮术（ECC）在诊断≥宫颈上皮内瘤变（CIN）II中的相对重要性。研究设计 在一项筛查研究中，对364例阴道镜检查结果满意且诊断为≥CIN II的女性进行了研究。所有阴道镜检查发现的病变均进行活检。如果阴道镜检查显示宫颈象限无病变，则在该象限的鳞柱交界处进行随机活检。然后进行ECC。
结果
57.1%的女性通过阴道镜引导下活检诊断为≥CIN II，37.4%通过随机活检诊断，5.5%通过ECC诊断。当细胞学检查为高级别时，随机活检诊断≥CIN II的检出率（17.6%）超过低级别时（2.8%）。仅通过ECC诊断的20例女性中有1例患有浸润癌。
结论
即使阴道镜检查结果满意，也应进行ECC。如果细胞学检查为高级别，应考虑进行随机活检。
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