Zhao Yu-qian, Chang Irene J, Zhao Fang-hui, Hu Shang-ying, Smith Jennifer S, Zhang Xun, Li Shu-min, Bai Ping, Zhang Wen-hua, Qiao You-lin
Department of Cancer Epidemiology, Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, 17 South Panjiayuan Lane, PO Box 2258, 100021, Beijing, China.
University of Miami Miller School of Medicine, 3303 Pinehurst Drive, Boynton Beach, FL, USA.
BMC Cancer. 2015 Jun 27;15:485. doi: 10.1186/s12885-015-1494-4.
Controversy remains whether a pattern of cervical intraepithelial neoplasia exists on the cervix. Our study aims at determining if the prevalence of histologically proven lesions differs by cervical four-quadrant location or by 12 o'clock surface locations of diagnosis.
We conducted a retrospective, histopathological study of 19 different population based cervical cancer screening studies from 1999 to 2010 by Cancer Hospital of Chinese Academy of Medical Sciences. The Institutional Review Board for human research subjects at CHCAMS approved all of the studies. During the colposcopy procedure, participant received either 4-quadrant biopsy or directed biopsy with/without endocervical curettage. Data of all samples were stratified by the methods of sampling. Kruskal-Wallis test was used to determine overall distribution of normal/CIN1, CIN2 and CIN3+ on the cervix.
In total, 53,088 cervical samples were included in distribution analysis. 66.9% samples were obtained by random biopsy, 16.1% were by directed biopsy, and 17.0% were by endocervical curettage. 95.9%of the biopsied samples were diagnosed as normal/CIN1, 2.0% were CIN2, and 2.1% were CIN3+. CIN2 and CIN3+ were most often found in quadrants 2 and 3 (χKW2=46.6540, p<0.0001) and at the 4- and 7-o'clock positions by directed biopsy (ORCIN2=2.572, 1.689, ORCIN3+=3.481, 1.678, respectively), and at the 5-, 6-, 7-, 9- and 12-o'clock positions by random biopsy. CIN3+ was least often found at the 11-o'clock position by directed biopsy (OR=0.608).
Our results suggest a predisposition of specific locations on the cervix to CIN occurrence. Quadrants 2 and 3, especially the 4- and 7-o'clock positions should be preferentially targeted during biopsy. The decision for random biopsy should be reconsidered in future studies.
子宫颈上是否存在宫颈上皮内瘤变模式仍存在争议。我们的研究旨在确定经组织学证实的病变患病率是否因子宫颈的四个象限位置或诊断的12点表面位置而异。
我们对中国医学科学院肿瘤医院1999年至2010年开展的19项不同的基于人群的子宫颈癌筛查研究进行了回顾性组织病理学研究。中国医学科学院肿瘤医院人体研究对象机构审查委员会批准了所有研究。在阴道镜检查过程中，参与者接受了四象限活检或直接活检，伴或不伴有宫颈管刮除术。所有样本的数据按采样方法进行分层。采用Kruskal-Wallis检验确定子宫颈上正常/CIN1、CIN2和CIN3+的总体分布情况。
共有53,088份子宫颈样本纳入分布分析。66.9%的样本通过随机活检获得，16.1%通过直接活检获得，17.0%通过宫颈管刮除术获得。95.9%的活检样本被诊断为正常/CIN1，2.0%为CIN2，2.1%为CIN3+。CIN2和CIN3+最常出现在第2和第3象限（χKW2=46.6540，p<0.0001），直接活检时出现在4点和7点位置（ORCIN2分别为2.572、1.689，ORCIN3+分别为3.481、1.678），随机活检时出现在5点、6点、7点、9点和12点位置。直接活检时，CIN3+在11点位置出现的频率最低（OR=0.608）。
我们的结果表明子宫颈上特定位置易发生CIN。活检时应优先针对第2和第3象限，尤其是4点和7点位置。未来研究应重新考虑随机活检的决策。
