Zhang Ling, Du Hui, Zhang Wei, Yang Bin, Wang Chun, Belinson Jerome L, Wu Ruifang
Shenzhen Key Laboratory of Gynecological Diagnostic Technology Research, Peking University Shenzhen Hospital, Shenzhen 518036, China.
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Zhonghua Fu Chan Ke Za Zhi. 2015 Apr;50(4):263-7.
To investigate the value of multiply biopsies and endocervical curettage (ECC) on diagnosing cervical lesions.
For the detection of cervical lesions, Shenzhen cervical cancer screening trial II (SHENCCAST II) program combined methods of HPV screening with liquid-based cytology (LBC), any positive indicators was then performed multiply biopsies and ECC under colopscopy. A total of 2,558 clear colposcopic images and pathological diagnoses were reviewed. To analyse the pathological results and primary screening results of the negative colopscopic images for discussing the value of multiply biopsies and ECC.
Overall 2,558 women's colposcopic images and sampling results were completed and validated. 69.98% (1,790/2,558) women had normal colposcopy appearances. Among them, 2.23% (40/1,790) were diagnosed as cervical intraepithelial neoplasia II or worse (CIN II+). The odds ratio of high-grade squamous intraepithelial lesion (HSIL) was 28.37 (P=0.000) and atypical squamous cell cannot exclude HSIL (ASC-H) was 15.07 (P=0.001). HPV types 16, 52, 58, 31, 33 and 18 were related to high-grade cervical lesion with the odds ratio of 3.11 (P=0.017). Hybrid capture II (HC-II) DNA test results shown that women with HPV positive were 3.58 times more risky than those of HPV negative, which was related to high-grade cervical lesion (P=0.025). Among the 2,558 women, CIN II+ detective rate from ECC were 40.7% (44/108) in older group (≥40 years) were higher than that of 19.2% (24/125) in younger group (<40 years; χ2=13.01, P=0.000). CIN II+ detective rate from multiply biopsies were 90.7% (98/108) in older group (≥40 years) were higher than that of 88.8% (111/125) in younger group (<40 years; χ2=0.24, P>0.05). The highest risky items of detecting CIN II+ were as follows: (1) HSIL or ASC-H; (2) HPV types 16, 18, 52 and 58 positive (either one); (3) HC-II HPV positive, at least 2 of the 3 items were included among 32 cases of the 40 CIN II+ with normal colposcopy appearances.
The results shown that only performed multi-site biopsies with abnormal colposcopy appearances may be missed some highgrade cervical lesion. For the positive indicators during screening should be performed randomly multi-sites biopsies and ECC under colopscopy, which may be helpful to reduce miss diagnosis.
探讨多点活检及宫颈管搔刮术（ECC）在诊断宫颈病变中的价值。
在深圳宫颈癌筛查试验II（SHENCCAST II）项目中，采用人乳头瘤病毒（HPV）筛查与液基细胞学检查（LBC）相结合的方法检测宫颈病变，对任何阳性指标者在阴道镜下进行多点活检及ECC。共回顾了2558例清晰的阴道镜图像及病理诊断结果。分析阴性阴道镜图像的病理结果及初筛结果，以探讨多点活检及ECC的价值。
共完成并验证了2558例女性的阴道镜图像及取材结果。69.98%（1790/2558）的女性阴道镜表现正常。其中，2.23%（40/1790）被诊断为宫颈上皮内瘤变II级或更高级别（CIN II+）。高级别鳞状上皮内病变（HSIL）的比值比为28.37（P = 0.000），非典型鳞状细胞不排除HSIL（ASC-H）的比值比为15.07（P = 0.001）。HPV 16、52、58、31、33和18型与高级别宫颈病变相关，比值比为3.11（P = 0.017）。杂交捕获II（HC-II）DNA检测结果显示，HPV阳性女性发生高级别宫颈病变的风险是HPV阴性女性的3.58倍（P = 0.025）。在2558例女性中，老年组（≥40岁）ECC的CIN II+检出率为40.7%（44/108），高于年轻组（<40岁）的19.2%（24/125）（χ2 = 13.01，P = 0.000）。老年组（≥40岁）多点活检的CIN II+检出率为90.7%（98/108），高于年轻组（<40岁）的88.8%（111/125）（χ2 = 0.24，P>0.05）。检测CIN II+的最高风险因素如下：（1）HSIL或ASC-H；（2）HPV 16、18、52和58型阳性（任一）；（3）HC-II HPV阳性，40例阴道镜表现正常的CIN II+病例中的32例至少包含这3项中的2项。
结果表明，仅对阴道镜表现异常者进行多点活检可能会遗漏一些高级别宫颈病变。对于筛查中的阳性指标，应在阴道镜下随机进行多点活检及ECC，这可能有助于减少漏诊。
