Diedrich Justin Thomas, Felix Juan C, Lonky Neal M
1Department of Obstetrics and Gynecology, University of California, Irvine; 2Department of Gynecologic Pathology, University of Southern California, Los Angeles; and 3Department of Obstetrics and Gynecology, Kaiser Permanente, Anaheim, CA.
J Low Genit Tract Dis. 2016 Jan;20(1):52-6. doi: 10.1097/LGT.0b013e3182a5296e.
To determine the utility of random biopsy and endocervical curettage (ECC) during colposcopy among women who ultimately underwent cervical excisional biopsy.
In a retrospective observational study, the charts were reviewed of every patient who underwent cervical excisional procedure performed between June 2010 and August 2011, including the antecedent colposcopic examination and any pathological specimens. A random sample of 15% all pathologic specimens was reviewed. Practice of biopsy, use of ECC, demographic factors, referral cytology results, lesion distribution, and size were assessed for correlation with high-grade cervical intraepithelial neoplasia 2 or worse (CIN 2+).
A total of 555 patients were included in our analysis. Of them, 333 (60%) had CIN 2+ on colposcopy or excision. CIN 2+ was most likely in younger women and those referred for high-grade cytology. Among 111 women with no visual lesion seen at colposcopy, 66 underwent ECC alone, 33 had ECC and random biopsy, 9 were referred straight to excision, and 3 underwent random biopsy alone. Of the 99 who underwent ECC, this was consistent with the highest-grade lesion in 68% of cases. Among the 36 with random biopsy, this was consistent with the highest-grade lesion in 72% of cases.At the time of colposcopy, there were 326 who had CIN 2+ diagnosed with satisfactory colposcopy. Biopsy and ECC were performed in 278 cases. In 235 cases, biopsy alone showed CIN 2+; in 43, the biopsy and ECC both showed CIN 2+. In the remaining 48 cases, CIN 2+ was diagnosed with ECC alone.
In those ultimately treated with excision, younger women and those whose referral cytology was high-grade both were at higher risk of high-grade histology. Random biopsy and ECC (even among satisfactory colposcopy) were significantly associated with disclosure of high-grade pathology.
确定在最终接受宫颈切除活检的女性中，阴道镜检查时随机活检和宫颈管搔刮术（ECC）的效用。
在一项回顾性观察研究中，对2010年6月至2011年8月期间接受宫颈切除手术的每位患者的病历进行了回顾，包括之前的阴道镜检查和任何病理标本。对所有病理标本的15%进行随机抽样审查。评估活检实践、ECC的使用、人口统计学因素、转诊细胞学结果、病变分布和大小与高级别宫颈上皮内瘤变2级或更严重病变（CIN 2+）的相关性。
共有555例患者纳入我们的分析。其中，333例（60%）在阴道镜检查或切除时发现CIN 2+。CIN 2+在年轻女性和转诊进行高级别细胞学检查的女性中最为常见。在111例阴道镜检查未发现可见病变的女性中，66例仅接受了ECC，33例接受了ECC和随机活检，9例直接转诊进行切除，3例仅接受了随机活检。在接受ECC的99例患者中，68%的病例结果与最高级别病变一致。在接受随机活检的36例患者中，72%的病例结果与最高级别病变一致。在阴道镜检查时，有326例通过满意的阴道镜检查诊断为CIN 2+。278例进行了活检和ECC。235例中，仅活检显示为CIN 2+；43例中，活检和ECC均显示为CIN 2+。在其余48例中，仅通过ECC诊断为CIN 2+。
在最终接受切除治疗的患者中，年轻女性和转诊细胞学检查为高级别的女性发生高级别组织学病变的风险更高。随机活检和ECC（即使在阴道镜检查满意的情况下）与高级别病理结果的发现显著相关。
