Zhang Xiaodan, Dou Yuya, Wang Mateng, Li Yang, Wang Fenfen, Xie Xing, Wang Xinyu
Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Xueshi Rd#2, Hangzhou, Zhejiang 310006, China; Ningbo No 2 hospital, Xibei Rd#41, Ningbo, Zhejiang 315000, China.
Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Xueshi Rd#2, Hangzhou, Zhejiang 310006, China; College of Life Science, Southwest University, Gaotanyanzheng Rd#30,Chongqing, 400038, China.
Eur J Obstet Gynecol Reprod Biol. 2017 Oct;217:53-58. doi: 10.1016/j.ejogrb.2017.07.005. Epub 2017 Jul 5.
Clinically, an unbefitting management for high grade squamous intraepithelial lesion (HSIL) may result from an inaccurate diagnosis by colposcopy bioposy.The study aimed to assess the diagnostic accuracy by colposcopic biopsy and evaluate the associated factors in diagnosing HSIL.
Clinical data of 1901 women who were primarily diagnosed as HSIL by colposcopic biopsy and then underwent definitive surgery within six-month interval in Women's Hospital, School of Medicine, Zhejiang University during 2009-2015, were retrospectively collected. The diagnostic accuracy of HSIL by colposcopic biopsy was assessed and the correlations between diagnostic accuracy and clinic-pathological variables were calculated by univariate and multivariate analysis using the pathological diagnosis by definitive surgery as a reference standard.
The accordance rate of HSIL diagnosis between colposcopic biopsy and definitive surgery was 80.6%, with an under-diagnosis rate of 5.8% and an over-diagnosis rate of 13.6%. Cytology≤low grade squamous intraepithelial lesion(LSIL) (OR:1.599;95%CI:1.185-2.160), colposcopy≤LSIL (OR:2.083;95%CI:1.537-2.824), endocervical curettage (ECC)≤LSIL(OR:2.813;95%CI:2.051-3.857), and lesion without gland involved (OR:1.751;95%CI:1.299-2.361) were independent risk factors for over-diagnosis of HSIL. Women with≥3 risk factors had a 5.078-flod higher risk for over-diagnosis of HSIL compared to those with≤1 risk factor. Irregular vaginal bleeding (OR:2.570,95%CI:1.668-3.960), colposcopy=HSIL (OR:1.699,95%CI:1.022-2.824), ECC=HSIL (OR:2.666, 95%CI:1.728-4.113), and multiple biopsies (OR:1.818, 95%CI:1.153-2.868) were independent risk factors for under-diagnosis of HSIL. Women with ≥3 risk factors had a 5.710-flod higher risk for under-diagnosis of HSIL compared to those with ≤1 risk factor.
The diagnostic accuracy of HSIL by colposcopic biopsy is about 80% and associated with some factors including symptom, cytology result, colposcopy diagnosis, and biopsy number. These variables may be predictors for over-diagnosis or under-diagnosis of HSIL by colposcopic biopsy.
临床上，对高级别鳞状上皮内病变（HSIL）管理不当可能源于阴道镜活检诊断不准确。本研究旨在评估阴道镜活检的诊断准确性，并评估诊断HSIL的相关因素。
回顾性收集了2009年至2015年期间在浙江大学医学院附属妇产科医院接受阴道镜活检初步诊断为HSIL且在6个月内接受确定性手术的1901名女性的临床资料。以确定性手术的病理诊断为参考标准，通过单因素和多因素分析评估阴道镜活检诊断HSIL的准确性，并计算诊断准确性与临床病理变量之间的相关性。
阴道镜活检与确定性手术对HSIL的诊断符合率为80.6%，漏诊率为5.8%，误诊率为13.6%。细胞学检查结果≤低级别鳞状上皮内病变（LSIL）（OR：1.599；95%CI：1.185-2.160）、阴道镜检查结果≤LSIL（OR：2.083；95%CI：1.537-2.824）、宫颈管搔刮术（ECC）结果≤LSIL（OR：2.813；95%CI：2.051-3.857）以及病变未累及腺体（OR：1.751；95%CI：1.299-2.361）是HSIL误诊的独立危险因素。有≥3个危险因素的女性与有≤1个危险因素的女性相比，HSIL误诊风险高5.078倍。不规则阴道出血（OR：2.570，95%CI：1.668-3.960）、阴道镜检查结果=HSIL（OR：1.699，95%CI：1.022-2.824）、ECC结果=HSIL（OR：2.666，95%CI：1.728-4.113）以及多次活检（OR：1.818，95%CI：1.153-2.868）是HSIL漏诊的独立危险因素。有≥3个危险因素的女性与有≤1个危险因素的女性相比，HSIL漏诊风险高5.710倍。
阴道镜活检诊断HSIL的准确性约为80%，且与一些因素相关，包括症状、细胞学检查结果、阴道镜诊断和活检次数。这些变量可能是阴道镜活检对HSIL误诊或漏诊的预测因素。
