Zhu Y L, Zhang W H, Liu B B, Zhang P, Zhang J, Wang L
Department of Gynecologic Oncology, Xuzhou Hospital Affiliated to Jiangsu University/Xuzhou Cancer Hospital, Xuzhou 221000, China.
Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China.
Zhonghua Fu Chan Ke Za Zhi. 2020 May 25;55(5):322-326. doi: 10.3760/cma.j.cn112141-20200211-00093.
To explore the preliminary clinical values of colposcopy in the diagnosis of vaginal invasion in cervical cancer. A retrospective review of the clinical records of patients (31 cases) with cervical cancer treated in Xuzhou Cancer Hospital from April 2015 to August 2019. For those with early-stage cervical cancer and the vagina invasion being difficult to be determined, those with advanced cervical cancer and the scope of vaginal invasion being difficult to be judged, and those with obvious vaginal tumor and underexposed cervix or inconspicuous cervical lesion and the primary location needing to be identified, colposcopy-guided vaginal and cervix biopsy were performed before treatment. (1) Image characteristics of colposcopy and pathological diagnosis: among 31 cases, 30 of them had the similar images of vagina and cervix. The images were dense acetowhite and (or) thick mosaic, coarse punctate and atypical vessels. Lugol's staining was uniformly bright yellow or brown. Pathological biopsy of vaginal wall: 27 cases were metastatic carcinoma, 3 cases were vaginal intraepithelial neoplasia (VaIN) Ⅱ-Ⅲ. One case showed dense acetowhite epithelium and atypical vessels image in cervix and thin acetowhite epithelium in upper 1/3 vagina which disappeared in two minutes; the results of vaginal biopsy was chronic inflammation. (2) Vaginal invasion diagnosed by colposcopy: among 31 cases, 14 of them without invasion of uterine side, vaginal invasion was judged as followed by colposcopy, being consistent with biopsy: 1 case of chronic vaginitis, 2 cases VaINⅡ, 1 case VaINⅢ, 6 cases upper 1/3 vagina invasion, 4 cases lower 1/3 vagina invasion. Among 10 cases with invasion of uterine side, vaginal invasion were identified by colposcopy, being consistent with biopsy: 4 cases upper 1/3 vagina invasion and 6 cases upper 1/2 vagina invasion. Five cases who had clinical diagnosis of vaginal cancer were diagnosed as cervical cancer with vaginal invasion by colposcopy, being consistent with biopsy. Two cases with no obvious lesions of cervix and vagina were diagnosed as cervical cancer with vaginal invasion by colposcopy, being consistent with cervical and vaginal biopsy: 1 case with stage Ⅳ (transfer to the left supraclavicular lymph node) and 1 case with stage Ⅱ a1. Colposcopy and multi-point biopsy have complementary diagnostic value for the cervical cancer cases that the invasion and scope of vagina are difficult to be determined by physical examination and (or) imaging examination. Thus the range of vaginal resection for patients underwent operation and the lower boundary of pelvic radiation field for those underwent radiotherapy could be fixed, so as to make the treatment much more individualized and humanized; the indications need further discussion.
探讨阴道镜检查在宫颈癌阴道浸润诊断中的初步临床价值。回顾性分析2015年4月至2019年8月在徐州市肿瘤医院接受治疗的31例宫颈癌患者的临床资料。对于早期宫颈癌且难以确定是否存在阴道浸润者、晚期宫颈癌且难以判断阴道浸润范围者、阴道肿物明显且宫颈暴露不佳或宫颈病变不明显且需明确原发部位者，在治疗前行阴道镜引导下阴道及宫颈活检。（1）阴道镜图像特征及病理诊断：31例中，30例阴道及宫颈图像相似。图像表现为醋酸白浓厚和（或）粗大镶嵌、粗大点状及异型血管。碘染色呈均匀亮黄色或棕色。阴道壁病理活检：27例为转移性癌，3例为阴道上皮内瘤变（VaIN）Ⅱ - Ⅲ级。1例宫颈呈醋酸白浓厚上皮及异型血管图像，阴道上段1/3为淡薄醋酸白上皮，2分钟后消失；阴道活检结果为慢性炎症。（2）阴道镜诊断阴道浸润情况：31例中，14例无宫旁浸润，阴道镜判断阴道浸润情况与活检结果相符：慢性阴道炎1例，VaINⅡ级2例，VaINⅢ级1例，阴道上段1/3浸润6例，阴道下段1/3浸润4例。10例有宫旁浸润者，阴道镜判断阴道浸润情况与活检结果相符：阴道上段1/3浸润4例，阴道上段1/2浸润6例。5例临床诊断为阴道癌者，经阴道镜诊断为宫颈癌伴阴道浸润，与活检结果相符。2例宫颈及阴道无明显病变者，经阴道镜诊断为宫颈癌伴阴道浸润，与宫颈及阴道活检结果相符：1例为Ⅳ期（左锁骨上淋巴结转移），1例为Ⅱa1期。对于体格检查和（或）影像学检查难以确定阴道浸润情况及范围的宫颈癌病例，阴道镜及多点活检具有互补诊断价值。从而可为手术患者确定阴道切除范围及放疗患者确定盆腔放疗野的下界，使治疗更具个体化和人性化；其适应证尚需进一步探讨。
