宫颈评估中的宫颈内膜刮除术。
Endocervical curettage in cervical evaluation.
机构信息
Department of Gynecology, University Hospital, Hotel-Dieu, and Department of Mathematics and Statistics, University of Montreal, Montreal, Canada.
出版信息
J Low Genit Tract Dis. 2000 Jul;4(3):125-7. doi: 10.1046/j.1526-0976.2000.43002.x.
OBJECTIVE
To evaluate the role of endocervical curettage (ECC) in the diagnosis of cervical intraepithelial neoplasia.
MATERIALS AND METHODS
Retrospectively we studied 581 patients who had ECC, 43 (7.4%) had cervical intraepithelial lesions (CIN) 1 ECC, 23 (4.0%) CIN 2-3 ECC, and 515 negative ECC (88.6%). Analysis of variance was used to compare for age and parity, and Pearson's chi-square test was used to analyze the association with other variables such as cytology, images, acetowhite epithelium, microbiopsy, and ECC. Significance level was set at p = 0.05.
RESULTS
Age for CIN 1 ECC was at 32.3 (16-66) years; parity was at 0.82 (parity 0-7) compared with 35.2 (18-70) years and parity at 1.52 (parity 0-12) for CIN 2-3 ECC, and 36.1 (14-68) years, parity at 1.1 (parity 0-10) for negative ECC. ECC is associated with Cytobrush cytology (Zelsmyr Cytobrush, International Cytobrush Inc., Hollywood. FL) (p = 0.000) in CIN 2-3 ECC and high-grade squamous intraepithelial lesion (HGSIL) cytology. Positive ECC was not overrepresented in unsatisfactory colposcopy (14/61, 23%) compared with negative ECC (158/526, 30%, p = 0.43). If positive ECC is not associated with the presence of significant acetowhite epithelium, a net association (p = 0.000) was observed between CIN 1 microbiopsies and CIN 1 ECC 9 (12/19), and CIN 2-3 biopsies and CIN 2-3 ECC (12/17). Conization for CIN 2-3 ECC (n = 23) yielded 15 CIN 2-3, two CIN 1, one microinvasive cervical cancer, one cancer of the cervix, and four negative cones.
CONCLUSIONS
Positive endocervical curettage is associated with endocervical cytology and microbiopsy. In ablative treatments, when low-grade squamous intraepithelial lesion (LGSIL) smear, satisfactory colposcopy, and CIN 1 biopsy is observed, ECC appears unnecessary since CIN 2-3 ECC was not observed in these patients. All other cases should have ECC prior to ablative therapy. CIN 2-3 ECC, commands conization, in order to eliminate invasive cancer, and confirm and treat CIN 2-3. ▪.
目的
评估宫颈内膜刮除术（ECC）在宫颈上皮内瘤变诊断中的作用。
材料和方法
我们回顾性研究了 581 例接受 ECC 的患者，其中 43 例（7.4%）ECC 为宫颈上皮内病变（CIN）1 级，23 例（4.0%）ECC 为 CIN 2-3 级，515 例 ECC 为阴性（88.6%）。采用方差分析比较年龄和产次，采用 Pearson 卡方检验分析与细胞学、影像学、醋酸白上皮、微生物活检和 ECC 等其他变量的相关性。显著性水平设定为 p = 0.05。
结果
CIN 1 ECC 的年龄为 32.3（16-66）岁；产次为 0.82（产次 0-7），而 CIN 2-3 ECC 的年龄为 35.2（18-70）岁，产次为 1.52（产次 0-12），阴性 ECC 的年龄为 36.1（14-68）岁，产次为 1.1（产次 0-10）。ECC 与 Cytobrush 细胞学（Zelsmyr Cytobrush，International Cytobrush Inc.，Hollywood，FL）（p = 0.000）相关，与 CIN 2-3 ECC 和高级别鳞状上皮内病变（HGSIL）细胞学相关。不满意阴道镜检查中阳性 ECC 并不比阴性 ECC（158/526，30%，p = 0.43）更常见。如果阳性 ECC 与明显醋酸白上皮不存在相关性，则可观察到 CIN 1 微生物活检与 CIN 1 ECC（9/19）之间存在净相关性（p = 0.000），CIN 2-3 活检与 CIN 2-3 ECC（12/17）之间存在净相关性。CIN 2-3 ECC 的锥切术（n = 23）得到 15 例 CIN 2-3，2 例 CIN 1，1 例微浸润宫颈癌，1 例宫颈癌，4 例阴性锥切。
结论
阳性宫颈内膜刮除术与宫颈内膜细胞学和微生物活检相关。在消融治疗中，当观察到低级别鳞状上皮内病变（LGSIL）涂片、满意的阴道镜检查和 CIN 1 活检时，ECC 似乎没有必要，因为这些患者中未观察到 CIN 2-3 ECC。所有其他病例在消融治疗前均应进行 ECC。CIN 2-3 ECC 需要行锥切术，以消除浸润性癌，并确认和治疗 CIN 2-3。
Zotero 插件