Song Y, Wang Q, Sui L, Gao S J
Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.
Zhonghua Fu Chan Ke Za Zhi. 2018 Mar 25;53(3):178-182. doi: 10.3760/cma.j.issn.0529-567X.2018.03.007.
To evaluate the accuracy of colposcopic biopsy on diagnosis of cervical adenocarcinoma in situ (AIS) and the clinical significance of loop electrosurgical excisional procedure (LEEP) on diagnosis and treatment of AIS and invasive adenocarcinoma. All medical records of 193 patients diagnosed as AIS by colposcopic biopsy and (or) AIS or invasive adenocarcinoma diagnosed by LEEP conization from Jan. 2015 to Dec. 2016 in Obstetrics and Gynecology Hospital of Fudan University were retrospectively reviewed. The final diagnosis was based on colposcopic biopsy or LEEP or the highest grade of pathological diagnosis after hysterectomy. In the 193 patients, 155 cases were finally diagnosed as AIS and 38 cases as invasive adenocarcinoma by histopathologic examination. Among the 155 AIS patients, 21.9% (34/155) had positive cone margins, in which 26 patients had hysterectomy, 30.8% (8/26) had residual disease in hysterectomy specimens; 78.1% (121/155) had negative cone margins, 68 patients with negative margins had hysterectomy and 5.9% (4/68) had residual disease, which was significantly lower than that with positive margins (χ(2)=10.46, =0.001) . One hundred and twenty from one hundred ninty-three (62.3%, 120/193) with AIS were detected by colposcopy. Pathological diagnosis of 50.8% (98/193) cases were upgraded after LEEP conization. Colposcopy is indispensable for the diagnosis of AIS, but accurate diagnosis should be made by LEEP. LEEP is capable of detecting AIS or cervical adenocarcinoma that was misdiagnosed by colposcopy, which is a pivotal method for accurate diagnosis. The margin status of LEEP is important for patients in choosing further hysterectomy, but the presence of cervical adenocarcinoma should always be aware of.
评估阴道镜活检诊断宫颈原位腺癌（AIS）的准确性以及环形电切术（LEEP）对AIS和浸润性腺癌诊断及治疗的临床意义。回顾性分析2015年1月至2016年12月在复旦大学附属妇产科医院经阴道镜活检诊断为AIS和（或）经LEEP锥切诊断为AIS或浸润性腺癌的193例患者的所有病历资料。最终诊断基于阴道镜活检、LEEP或子宫切除术后的最高病理诊断级别。193例患者中，经组织病理学检查最终诊断为AIS 155例，浸润性腺癌38例。155例AIS患者中，切缘阳性者占21.9%（34/155），其中26例行子宫切除术，子宫切除标本中有残留病灶者占30.8%（8/26）；切缘阴性者占78.1%（121/155），68例切缘阴性者行子宫切除术，有残留病灶者占5.9%（4/68），明显低于切缘阳性者（χ(2)=10.46，P =0.001）。193例AIS患者中120例（62.3%，120/193）经阴道镜检出。LEEP锥切术后50.8%（98/193）病例的病理诊断级别升高。阴道镜检查对AIS诊断不可或缺，但准确诊断应依靠LEEP。LEEP能够检出阴道镜误诊的AIS或宫颈腺癌，是准确诊断的关键方法。LEEP切缘情况对患者选择进一步子宫切除术很重要，但应始终警惕宫颈腺癌的存在。
