Fan Aiping, Zhang Liqin, Wang Chen, Wang Yingmei, Han Cha, Xue Fengxia
Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154, Anshan Road, He Ping District, Tianjin, 300052, China.
Arch Gynecol Obstet. 2017 Nov;296(5):965-972. doi: 10.1007/s00404-017-4500-z. Epub 2017 Sep 9.
Many factors affect the accuracy of colposcopically directed biopsy (CDB). This study aimed to compare the histological results of CDB with those of cone specimens and to determine clinical factors associated with the accuracy of CDB in defining the extent and severity of cervical intraepithelial neoplasia.
We studied 513 patients diagnosed with cervical intraepithelial neoplasia by CDB who underwent conization between September 2012 and December 2016. We retrospectively evaluated the agreement between histological results on biopsies and cone specimens and analyzed factors influencing the accuracy of the results.
The overall agreement between the histological results on biopsy and the corresponding cone specimens was 74.1%; underestimation occurred in 6.4% of cases. The agreement between histological results on biopsy and cone specimen was 54.5% for low-grade lesions, 78.2% for high-grade lesions, and 28.9% for microinvasive cervical cancer. The overall agreement between high-grade cytology and the final histological diagnosis was 86.7%. By univariate analysis, patient age (p = 0.026), menopausal status (p = 0.018), type of transformation zone (p = 0.003), number of biopsies (p = 0.002), and cone width (p = 0.015) were found to be associated with the accuracy of CDB. However, multivariate logistic regression revealed that cone width (p = 0.044) was the only independent factor correlated with CDB accuracy.
Our data suggest that old age (≥50), postmenopausal status, and transformation zone type 3 might be positively associated with the under-diagnosis of CDB. Three or more biopsies and cone width ≥21 mm might improve CDB accuracy. However, cone width was the only independent factor correlated with CDB accuracy.
许多因素会影响阴道镜引导下活检（CDB）的准确性。本研究旨在比较CDB与锥形切除标本的组织学结果，并确定与CDB在定义宫颈上皮内瘤变的范围和严重程度时的准确性相关的临床因素。
我们研究了2012年9月至2016年12月期间因CDB诊断为宫颈上皮内瘤变而接受锥形切除的513例患者。我们回顾性评估了活检和锥形切除标本的组织学结果之间的一致性，并分析了影响结果准确性的因素。
活检组织学结果与相应锥形切除标本的总体一致性为74.1%；6.4%的病例存在低估情况。活检与锥形切除标本组织学结果的一致性在低级别病变中为54.5%，高级别病变中为78.2%，宫颈微浸润癌中为28.9%。高级别细胞学与最终组织学诊断的总体一致性为86.7%。单因素分析发现，患者年龄（p = 0.026）、绝经状态（p = 0.018）、转化区类型（p = 0.003）、活检数量（p = 0.002）和锥形切除宽度（p = 0.015）与CDB的准确性相关。然而，多因素逻辑回归显示，锥形切除宽度（p = 0.044）是与CDB准确性相关的唯一独立因素。
我们的数据表明，年龄较大（≥50岁）、绝经后状态和3型转化区可能与CDB诊断不足呈正相关。三次或更多次活检以及锥形切除宽度≥21 mm可能会提高CDB准确性。然而，锥形切除宽度是与CDB准确性相关的唯一独立因素。
