阴道镜引导下活检诊断早期宫颈癌的准确性：一项回顾性研究。
Accuracy of colposcopy-directed biopsy in detecting early cervical neoplasia: a retrospective study.
机构信息
Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91052, Erlangen, Germany.
Department of Gynecology and Obstetrics, Klinikum Sindelfingen-Böblingen, Bunsenstrasse 120, 71032, Böblingen, Germany.
出版信息
Arch Gynecol Obstet. 2019 Feb;299(2):525-532. doi: 10.1007/s00404-018-4953-8. Epub 2018 Oct 27.
PURPOSE
Colposcopy-directed biopsy is a cornerstone method for diagnosing cervical intraepithelial neoplasia. The aim of this study was to evaluate the accuracy of colposcopy-directed biopsy in comparison with definitive surgery.
METHODS
The accuracy of colposcopy-directed biopsy was compared with the final histology in relation to different types of transformation zone (TZ), the patient's age, and the examiner's level of training.
RESULTS
The overall accuracy of biopsy in comparison with definitive surgery was 71.9% for all entities-benign lesions, low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions (HSILs), and cervical carcinoma-with an underdiagnosis rate of 11.8% and an overdiagnosis rate of 16.5%. The accuracy for detecting HSIL was 88% (401/455), with an underdiagnosis rate of 10.5% and overdiagnosis rate of 1.3%. The accuracy rates for detecting HSIL in women with TZ 1, TZ 2, or TZ 3 were 92.2, 90.5, and 76.5%, respectively. The accuracy rates for detecting HSIL in the different age groups were 93.1% (age 0-34), 83.6% (age 34-55), and 80% (age 55 or older).
CONCLUSIONS
A combination of the colposcopic findings, cytology, human papillomavirus testing, and colposcopy-directed biopsy is necessary for the correct diagnosis of HSIL. The accuracy rate depends on the TZ and the patient's age. The examiner's level of training does not have any substantial influence on the accuracy.
目的
阴道镜指导下活检是诊断宫颈上皮内瘤变的基石方法。本研究旨在评估阴道镜指导下活检与明确手术相比的准确性。
方法
将阴道镜指导下活检的准确性与最终组织学进行比较，比较的因素包括不同类型的转化区（TZ）、患者年龄和检查者的培训水平。
结果
与明确手术相比，所有实体（良性病变、低级别鳞状上皮内病变、高级别鳞状上皮内病变[HSIL]和宫颈癌）的活检总体准确性为 71.9%，低估率为 11.8%，高估率为 16.5%。检测 HSIL 的准确性为 88%（401/455），低估率为 10.5%，高估率为 1.3%。TZ 1、TZ 2 或 TZ 3 的女性检测 HSIL 的准确率分别为 92.2%、90.5%和 76.5%。不同年龄组检测 HSIL 的准确率分别为 93.1%（0-34 岁）、83.6%（34-55 岁）和 80%（55 岁及以上）。
结论
阴道镜检查结果、细胞学、人乳头瘤病毒检测和阴道镜指导下活检的结合对于正确诊断 HSIL 是必要的。准确率取决于 TZ 和患者的年龄。检查者的培训水平对准确率没有实质性影响。
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