Kabaca Canan, Koleli Isil, Sariibrahim Bahar, Karateke Ates, Gurbuz Ayse, Kapudere Bilge, Cetiner Handan, Cesur Suna
Departments of 1Gynecologic Oncology, and 2Pathology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey.
J Low Genit Tract Dis. 2014 Jul;18(3):240-5. doi: 10.1097/LGT.0b013e3182aa08f6.
This study aimed to analyze the correlation between the histopathologic results of excisional procedure and cervical punch biopsy and to investigate the accuracy rates of colposcopic punch biopsy and cervical cytology to detect cervical intraepithelial neoplasia (CIN) grade 2 and/or more severe lesions (CIN 2+).
Two hundred six patients who underwent excisional procedure in the gynecologic oncology clinic of the Zeynep Kamil Women and Children Diseases Education and Research Hospital between 2004 and 2011 were enrolled in a retrospective study.
The correlation between the pathologic findings gained by excisional procedure and punch biopsy was weak ( p = .0001, κ = 0.03). The overall concordance rate between the pathologic findings of cervical biopsy and excisional procedure was 57.29%. The rates of detecting more severe lesions by excisional procedure when compared to biopsies (biopsy underestimation) were 71.42%, 22.91%, 37.03%, and 12.72% for biopsy results with negative, CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. Similarly, the rates of less severe lesions diagnosed by excisional procedure when compared to biopsies (biopsy overestimation) were 29.16%, 40.74%, and 15.45% for biopsy results with CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. The rate of CIN 2+ lesions after excisional procedure in cases with previous biopsy results with either negative or CIN 1 was 27.27%.
Our results suggested that colposcopy-directed biopsy was neither a good diagnostic nor a reliable management method. We think that the indications of conization should be enlarged to avoid overlooking high-grade lesions.
本研究旨在分析切除手术与宫颈活检组织病理学结果之间的相关性，并探讨阴道镜下活检及宫颈细胞学检查对检测宫颈上皮内瘤变（CIN）2级及以上严重病变（CIN 2+）的准确率。
对2004年至2011年间在泽伊内普·卡米尔妇女儿童医院妇科肿瘤门诊接受切除手术的206例患者进行回顾性研究。
切除手术与活检所获病理结果之间的相关性较弱（p = 0.0001，κ = 0.03）。宫颈活检与切除手术病理结果的总体一致性率为57.29%。与活检结果相比，切除手术检测到更严重病变（活检低估）的比例分别为：活检结果为阴性、CIN 1、CIN 2和CIN 3/原位腺癌病变时，分别为71.42%、22.91%、37.03%和12.72%。同样，与活检结果相比，切除手术诊断出较轻病变（活检高估）的比例分别为：活检结果为CIN 1、CIN 2和CIN 3/原位腺癌病变时，分别为29.16%、40.74%和15.45%。既往活检结果为阴性或CIN 1的病例，切除手术后CIN 2+病变的发生率为27.27%。
我们的结果表明，阴道镜引导下活检既不是一种好的诊断方法，也不是一种可靠的管理方法。我们认为应扩大锥切术的适应证，以避免漏诊高级别病变。
