Behrens Annika S, Dietl Anna K, Adler Werner, Geppert Carol, Hartmann Arndt, Knöll Antje, Beckmann Matthias W, Mehlhorn Grit, Koch Martin C, E Schulmeyer Carla, Seibold A, Gass Paul, Stuebs Frederik A
Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Universitaetsstrasse 21-23, 91054, Erlangen, Germany.
Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 6, 91054, Erlangen, Germany.
Arch Gynecol Obstet. 2024 Dec;310(6):3037-3045. doi: 10.1007/s00404-024-07721-w. Epub 2024 Oct 29.
Diagnostic challenges in colposcopy arise especially in women aged 50 or older, with postmenopausal status and transformation zone type 3 (TZ3). Endocervical curettage (ECC) is a valuable tool for diagnosing intracervical lesions. The aim of this retrospective analysis was to evaluate the use of ECC in colposcopy for detecting cervical intraepithelial lesions.
A retrospective study was carried out of colposcopies performed in the certified Dysplasia Unit at Erlangen University Hospital between July 2016 and June 2023. Pap and human papillomavirus (HPV) results were correlated with the histologic findings via ECC, obtained during examinations or surgery. The primary outcome was the rate of accuracy between the colposcopic and histologic findings with regard to cytology, age of patients, and type of transformation zone (TZ).
A total of 429 colposcopies in 413 women with histologic samples obtained via ECC were included in the final analysis. In all, 355 women had TZ3. Among patients with TZ3, evidence of high-grade lesions and invasive carcinoma was also found in women with normal or low-grade abnormal cytology. For patients with normal colposcopic findings, cervical intraepithelial neoplasia (CIN) 2 and CIN 3/adenocarcinoma in situ (AIS) were found in 56 patients (16%), and invasive carcinoma was found in four patients (0.1%).
This analysis suggests that ECC is a valuable tool in the diagnosis of cervical intraepithelial neoplasia, especially for patients who present with a normal colposcopy of the cervix and vagina but have either recurrent abnormal cytologic findings or high-grade abnormal cytology indicating CIN 2 + .
阴道镜检查中的诊断挑战尤其出现在50岁及以上、处于绝经后状态且转化区类型为3型（TZ3）的女性中。宫颈管搔刮术（ECC）是诊断宫颈内病变的一项重要工具。本回顾性分析的目的是评估ECC在阴道镜检查中用于检测宫颈上皮内病变的应用情况。
对2016年7月至2023年6月在埃尔朗根大学医院认证的发育异常科室进行的阴道镜检查进行回顾性研究。通过检查或手术期间获得的ECC，将巴氏涂片和人乳头瘤病毒（HPV）检测结果与组织学检查结果相关联。主要结局是阴道镜检查结果与组织学检查结果在细胞学、患者年龄和转化区（TZ）类型方面的准确率。
最终分析纳入了413名通过ECC获得组织学样本的女性进行的429次阴道镜检查。共有355名女性为TZ3。在TZ3患者中，细胞学正常或低级别异常的女性中也发现了高级别病变和浸润癌的证据。阴道镜检查结果正常的患者中，56名患者（16%）发现了宫颈上皮内瘤变（CIN）2级和CIN 3级/原位腺癌（AIS），4名患者（0.1%）发现了浸润癌。
该分析表明，ECC是诊断宫颈上皮内瘤变的一项重要工具，尤其适用于宫颈和阴道阴道镜检查结果正常但细胞学检查结果反复异常或显示CIN 2级及以上高级别异常的患者。
