Wang Tong, Wu Yu-mei, Song Fang, Zhu Li, Li Bao-zhu, Hao Xia, Kong Wei-min, Duan Wei, Fan Ling, Zhang Wei-yuan
Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Zhonghua Fu Chan Ke Za Zhi. 2010 Jul;45(7):497-500.
To investigate the value and safety of biopsy guided by colposcopy in diagnosis of cervical diseases in pregnant women.
From Aug. 2007 to Feb. 2009, 17 828 pregnant women who receive antenatal examination underwent cervical cytological screening thinprep cytology test (TCT) in Beijing Obstetrics and Gynecology Hospital. If abnormal cytological results were found, those pregnant women were administered by colposcopic examination and biopsy after they signed informed consent.
(1) TCT: the abnormal TCT results of 1502 pregnant women (8.425%, 1502/17 828) were found in 17 828 cases. (2) Colposcopic examination: two hundred and four pregnant women underwent colposcopic examination. The rate of satisfied colposcopic imaging was 92.6% (189/204), colposcopic examination identified 125 cases with cervical inflammation or cervical intraepithelial neoplasia (CIN)I, 25 cases with CINII and 54 cases with CINIII or microinvasive squamous carcinoma (MIVC) of squamous cervical carcinoma (SCC). (3) The results of biopsy guided by colposcopy: among 204 cases, it was found 33 cases with cervical inflammation or wart, 95 cases with CINI, 28 CINII, 36 cases with CINIII and 12 cases with MIVC. (4) The rate of concordance: compared with biopsy pathologic examination, colposcopy examination found 113 cases with cervical inflammation and CINI, the rate of concordance was 90.4% (113/125). And 54 cases with CINIII or SCC diagnosed by colposcopy examination, however biopsy pathologic examination confirm 23 cases with CINIII and 10 cases with SCC at stage Ia, the concordance rate was 61% (33/54). (5) Complication: eight (3.9%, 8/204) pregnant women underwent cervical wound suturing due to continuous bleeding after colposcopy exam or biopsy. No other complications were recorded.
It is necessary that TCT should be performed in pregnant women without cytological screening within one year. Colposcopic examination and biopsy were indicated if pregnant woman with abnormal cytological result were found. Pregnant women with cervicitis or CINI diagnosed by colposcopy should be followed up. If pregnant woman was suspected with CINII or advanced disease, biopsy guided by colposcopy should be performed.
探讨阴道镜引导下活检在诊断孕妇宫颈疾病中的价值及安全性。
2007年8月至2009年2月，在北京妇产医院对17828例接受产前检查的孕妇进行宫颈细胞学筛查薄层液基细胞学检测（TCT）。若细胞学检查结果异常，这些孕妇在签署知情同意书后接受阴道镜检查及活检。
（1）TCT：17828例孕妇中，1502例（8.425%，1502/17828）TCT结果异常。（2）阴道镜检查：204例孕妇接受阴道镜检查。阴道镜图像满意率为92.6%（189/204），阴道镜检查确诊125例宫颈炎症或宫颈上皮内瘤变（CIN）I级，25例CINII级，54例CINIII级或宫颈微小浸润性鳞状细胞癌（MIVC）。（3）阴道镜引导下活检结果：204例中，发现33例宫颈炎症或湿疣，95例CINI级，28例CINII级，36例CINIII级，12例MIVC。（4）符合率：与活检病理检查相比，阴道镜检查发现113例宫颈炎症和CINI级，符合率为90.4%（113/125）。阴道镜检查诊断为CINIII级或鳞状细胞癌（SCC）的54例中，活检病理检查确诊23例CINIII级，10例Ia期SCC，符合率为61%（33/54）。（5）并发症：8例（3.9%，8/204）孕妇因阴道镜检查或活检后持续出血接受宫颈伤口缝合。未记录其他并发症。
对一年内未进行细胞学筛查的孕妇进行TCT检查很有必要。若发现孕妇细胞学检查结果异常，应进行阴道镜检查及活检。阴道镜诊断为宫颈炎或CINI级的孕妇应进行随访。若怀疑孕妇为CINII级或更严重疾病，应进行阴道镜引导下活检。
