Department of Obstetrics and Gynecology, Southern California Permanente Medical Group-Fontana, Fontana, CA, USA.
J Low Genit Tract Dis. 2011 Jul;15(3):180-8. doi: 10.1097/LGT.0b013e3181fb4547.
The objectives of this study were to compare the sensitivity of colposcopically directed biopsy (biopsy of cervical quadrants with colposcopic impressions of human papillomavirus, cervical intraepithelial neoplasia [CIN], or cancer) for CIN 3 or cancer (CIN 3+) among physicians and to estimate the increase in yield of CIN 3+ per colposcopy associated with "random" biopsies and/or endocervical curettage (ECC).
Two studies in which 7 physicians performed 1,383 colposcopic examinations on women with abnormal cervical cytology were reviewed. At colposcopy, the cervix was divided into quadrants by lines from the 12- to the 6-o'clock and from the 3- to the 9-o'clock positions. Each quadrant was assigned a colposcopic impression of normal, human papillomavirus or CIN 1, CIN 2 or CIN 3, or cancer. Each quadrant had biopsy of colposcopically detected lesions or "random" biopsy at the squamocolumnar junction if the colposcopic impression was normal. Lastly, ECC was obtained.
Among the physicians, the sensitivity of colposcopically directed biopsy for CIN 3+ varied from 28.6% to 92.9% (p < .001). With logistic regression, the sensitivity of colposcopically directed biopsy for CIN 3+ increased as the number of cervical quadrants with CIN 3+ increased (p < .001); once corrected for the number of quadrants with CIN 3+, differences between the physician's sensitivities remained significant (p = .01). For 6 of 7 physicians, the yield of CIN 3+ per colposcopy was greater when colposcopically directed biopsy was augmented by up to 4 "random" biopsies plus ECC (p = .03 to p < .001).
The sensitivity of colposcopy for CIN 3+ varies widely. Performing up to 4 "random" biopsies plus ECC increases the yield of CIN 3+.
本研究旨在比较阴道镜下指导活检（对阴道镜下人乳头瘤病毒、宫颈上皮内瘤变（CIN）或癌症印象、宫颈象限活检）诊断 CIN3 或更高级别病变（CIN3+）的敏感性，并评估增加阴道镜下随机活检和/或宫颈管搔刮术（ECC）对提高 CIN3+检出率的影响。
我们对 7 位医生进行的 1383 例阴道镜检查进行了 2 项研究。在阴道镜检查时，宫颈被分为 12 点至 6 点和 3 点至 9 点连线的 4 个象限。每个象限的阴道镜印象分别为正常、HPV 或 CIN1、CIN2 或 CIN3 和癌症。对阴道镜下可见病变或阴道镜印象正常的鳞柱交界区行随机活检。最后行 ECC。
在医生中，阴道镜下指导活检诊断 CIN3+的敏感性为 28.6%至 92.9%（p＜0.001）。应用 logistic 回归分析，CIN3+的宫颈象限数与阴道镜下指导活检的敏感性增加呈正相关（p＜0.001）；校正 CIN3+的宫颈象限数后，医生间的敏感性差异仍有统计学意义（p=0.01）。对于 7 位医生中的 6 位，阴道镜下指导活检增加 4 个随机活检加 ECC，可增加 CIN3+的检出率（p=0.03 至 p＜0.001）。
阴道镜诊断 CIN3+的敏感性差异较大。增加 4 个随机活检加 ECC 可提高 CIN3+的检出率。
