Schneider A, Wagner K, Rakozy C, Stolte C, Bothur-Schäfer P, Welcker T, Choly N, Roesgen A, Rothe H, Böhmer G
Institute for Dysplasia and Cytology, Berlin.
Institute for Dysplasia and Cytology, Hannover.
Geburtshilfe Frauenheilkd. 2015 Oct;75(10):1063-1068. doi: 10.1055/s-0035-1557816.
To evaluate, if targeted strip biopsies decrease trauma/pain perception while maintaining diagnostic accuracy in patients with the diagnosis of high-grade squamous intraepithelial lesions of the uterine cervix. Between July 1st and December 31st 2014 we performed colposcopically directed strip biopsies in 102 patients with colposcopic suspicion of high-grade squamous intraepithelial lesions of the uterine cervix. We used a 3 mm curette for harvesting tissue samples under VITOM® videocolposcopy. So far, 60 patients underwent additional loop excision. Histologic examination of strip biopsies and loop specimens included routine hematoxylin and eosin staining as well as immunohistochemical staining for p16, Ki 67 and stathmin-1. 55 patients (53 %), were histologically diagnosed with cervical intraepithelial neoplasia grade 3 on strip biopsies. Adenocarcinoma in situ was diagnosed in 2 patients (2 %), cervical intraepithelial neoplasia grade 2 in 35 patients (34 %), and cervical intraepithelial neoplasia grade 1 in 10 patients (10 %). The agreement between histologic results of strip biopsy and loop specimen was highly significant: In all 60 strip biopsies diagnosed with high-grade squamous intraepithelial lesions this diagnosis was confirmed histologically during follow-up loop specimen excision (high-grade squamous intraepithelial lesions in 58 patients, invasive disease in 2 patients). The pain level experienced during strip biopsy was rated on average 0.25 on a scale from 0 to 10. No clinically significant bleeding was reported. Targeted strip biopsies with a 3 mm curette are a reliable procedure to diagnose high-grade squamous intraepithelial lesions of the uterine cervix and yield high patient satisfaction ().
为评估靶向条带活检在维持诊断准确性的同时，是否能降低子宫颈高级别鳞状上皮内病变患者的创伤/疼痛感知。在2014年7月1日至12月31日期间，我们对102例经阴道镜检查怀疑有子宫颈高级别鳞状上皮内病变的患者进行了阴道镜引导下的条带活检。我们使用3毫米刮匙在VITOM®视频阴道镜下采集组织样本。到目前为止，60例患者接受了额外的环形切除术。条带活检和环形切除标本的组织学检查包括常规苏木精和伊红染色以及p16、Ki 67和Stathmin-1的免疫组化染色。55例患者（53%）经条带活检组织学诊断为宫颈上皮内瘤变3级。2例患者（2%）诊断为原位腺癌，35例患者（34%）诊断为宫颈上皮内瘤变2级，10例患者（10%）诊断为宫颈上皮内瘤变1级。条带活检和环形切除标本的组织学结果之间的一致性非常显著：在所有60例诊断为高级别鳞状上皮内病变的条带活检中，这一诊断在后续环形切除标本时经组织学证实（58例患者为高级别鳞状上皮内病变，2例患者为浸润性疾病）。条带活检期间经历的疼痛程度平均评分为0.25（0至10分）。未报告有临床意义的出血。使用3毫米刮匙进行靶向条带活检是诊断子宫颈高级别鳞状上皮内病变的可靠方法，患者满意度高。
