Souza Carlos André Scheler de, Discacciati Michelle Garcia, d'Otavianno Maria Gabriela, Bergo Silvia Maria, Traue Markus, Andrade Liliana Aparecida Lucci de Angelo, Zeferino Luiz Carlos
Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil.
Laboratory of Cytopathology, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil.
Rev Bras Ginecol Obstet. 2017 Mar;39(3):123-127. doi: 10.1055/s-0037-1599071. Epub 2017 Mar 6.
Expectant follow-up for biopsy-proven cervical intraepithelial neoplasia (CIN) 1 is the current recommendation for the management of this lesion. Nevertheless, the performance of the biopsy guided by colposcopy might not be optimal. Therefore, this study aimed to calculate the rate of underdiagnoses of more severe lesions in women with CIN 1 diagnosis and to evaluate whether age, lesion extent and biopsy site are factors associated with diagnostic failure. Eighty women with a diagnosis of CIN 1 obtained by colposcopy-guided biopsy were selected for this study. These women were herein submitted to large loop excision of the transformation zone (LLETZ). The prevalence of lesions more severe than CIN 1 was calculated, and the histological diagnoses of the LLETZ specimens were grouped into two categories: "CIN 1 or less" and "CIN 2 or worse." The prevalence of lesions diagnosed as CIN 2 or worse in the LLETZ specimens was of 19% (15/80). Three women revealed CIN 3, and 1 woman revealed a sclerosing adenocarcinoma stage I-a, a rare type of malignant neoplasia of low proliferation, which was not detected by either colposcopy or previous biopsy. The underdiagnosis of CIN 2 was not associated with the women's age, lesion extension and biopsy site. The standard methods used for the diagnosis of CIN 1 may underestimate the severity of the true lesion and, therefore, women undergoing expectant management must have an adequate follow-up.
对于经活检证实的宫颈上皮内瘤变（CIN）1，目前推荐进行观察随访来处理该病变。然而，阴道镜引导下活检的效果可能并不理想。因此，本研究旨在计算CIN 1诊断女性中更严重病变的漏诊率，并评估年龄、病变范围和活检部位是否为与诊断失败相关的因素。本研究选取了80例经阴道镜引导活检诊断为CIN 1的女性。这些女性接受了转化区大环形切除术（LLETZ）。计算比CIN 1更严重病变的患病率，并将LLETZ标本的组织学诊断分为两类：“CIN 1或更低级别”和“CIN 2或更高级别”。LLETZ标本中诊断为CIN 2或更高级别病变的患病率为19%（15/80）。3名女性显示为CIN 3，1名女性显示为I - a期硬化性腺癌，这是一种罕见的低增殖性恶性肿瘤，阴道镜检查或先前活检均未检测到。CIN 2的漏诊与女性年龄、病变范围和活检部位无关。用于诊断CIN 1的标准方法可能会低估真实病变的严重程度，因此，接受观察处理的女性必须进行充分的随访。
