Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark.
Acta Obstet Gynecol Scand. 2020 Aug;99(8):1064-1070. doi: 10.1111/aogs.13832. Epub 2020 Mar 9.
Dynamic spectral imaging (DSI) colposcopy has previously been found to improve sensitivity of CIN2+ detection. The aim of this study was to compare the histological diagnosis of colposcopic-directed biopsies (CDB) with that of DSI-directed biopsies in women undergoing conization, using the histological diagnosis of the conization specimen as gold standard.
Women referred for colposcopy were included in a prospective cohort study at Randers Regional Hospital, Denmark, from January 2016 to February 2019. All women had four cervical punch biopsies taken. The first biopsy was taken from the area that appeared most abnormal by conventional colposcopy (ie, CDB) and the second biopsy from the area that appeared most abnormal using the DSI map. An additional two biopsies were taken either from other visible lesions or as random biopsies. Biopsies were analyzed separately. If any biopsies revealed cervical dysplasia of such a degree that excisional treatment was recommended, the patient was referred for conization. Subsequently, we compared the histological diagnosis of CDB and DSI-directed biopsies with that of the cone biopsy.
A total of 573 women were enrolled, 170 of which underwent conization. In women with an adequate colposcopy and representative biopsies (n = 124) there was an overall agreement rate between the worst biopsy diagnosis (of any four) and the conization diagnosis in 95.2% (95% CI 89.8-98.2) of women. CDB diagnosis agreed with the cone diagnosis in 80.6% (95% CI 72.6-87.2) of women. DSI-directed biopsy agreed with the cone diagnosis in 83.9% (95% CI 76.2-89.9) of women. The difference in detection rate between the CDB and the DSI-directed biopsy was, however, not significant (P = .54). Taking four biopsies increases the detection rate of cervical dysplasia to 95.2%, which was a significant increase from both CDB alone (P = .0008) and DSI-directed biopsy alone (P = .0053).
We found no significant difference in the ability to identify the cervical dysplasia grade between CDB and DSI-directed biopsies. A higher detection rate of cervical dysplasia was achieved with four biopsies than with one CDB biopsy or one DSI-directed biopsy.
动态光谱成像（DSI）阴道镜检查先前已被发现可提高 CIN2+检测的灵敏度。本研究的目的是比较阴道镜指导活检（CDB）和 DSI 指导活检的组织学诊断，以宫颈锥切标本的组织学诊断为金标准。
2016 年 1 月至 2019 年 2 月，丹麦兰德斯地区医院对转诊行阴道镜检查的女性进行了一项前瞻性队列研究。所有女性均进行了 4 次宫颈穿刺活检。第一次活检取自传统阴道镜检查最异常的部位（即 CDB），第二次活检取自 DSI 图谱最异常的部位。另外两次活检取自其他可见病变或随机活检。活检结果单独分析。如果任何活检显示宫颈上皮内瘤变程度需要切除治疗，则患者转科行宫颈锥切术。随后，我们比较了 CDB 和 DSI 指导活检与锥切活检的组织学诊断结果。
共纳入 573 名女性，其中 170 名接受了锥切术。在阴道镜检查充分且活检具有代表性的女性（n=124）中，4 次活检中最差活检诊断（任何一次）与锥切诊断的总体一致性率为 95.2%（95%CI 89.8-98.2）。CDB 诊断与锥切诊断一致的女性为 80.6%（95%CI 72.6-87.2）。DSI 指导活检与锥切诊断一致的女性为 83.9%（95%CI 76.2-89.9）。然而，CDB 和 DSI 指导活检的检出率差异无统计学意义（P=0.54）。增加至 4 次活检可将宫颈上皮内瘤变的检出率提高至 95.2%，与单独进行 CDB 活检（P=0.0008）和 DSI 指导活检（P=0.0053）相比均有显著提高。
我们发现 CDB 和 DSI 指导活检在识别宫颈上皮内瘤变程度方面的能力无显著差异。与单独进行 1 次 CDB 活检或 1 次 DSI 指导活检相比，4 次活检可提高宫颈上皮内瘤变的检出率。
