Baldauf J J, Dreyfus M, Ritter J, Philippe E
Department of Obstetrics and Gynecology, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, France.
Acta Obstet Gynecol Scand. 1997 May;76(5):468-73. doi: 10.3109/00016349709047830.
To compare the results of colposcopically directed biopsy with the final diagnosis established by the analysis of the surgical specimen, and to determine the clinical and colposcopic factors on which the reliability of biopsy is based.
Five hundred and sixty-seven women were seen by the same colposcopist who also performed the directed biopsies and/or the endocervical curettage. The final histological diagnosis identified 29 normal aspects (5.2%), 58 low-grade cervical intraepithelial neoplasias (CIN) (10.2%), 448 high-grade CINs (79.0%), 16 microinvasive cancers (2.8%) and 16 occult invasive cancers (2.8%). The influence of several factors--such as age, parity, menopause, pregnancy, history of cervical treatment, site of the squamocolumnar junction, localization, size and severity of the lesions--on the pertinence of the biopsy was studied in a uni- and multifactorial analysis.
Colposcopy was satisfactory in 399 patients (70.4%) in whom the colposcopic aspect was consistent with the final histological diagnosis in 81.2% of cases. The global agreement between biopsy diagnosis and final diagnosis was observed in 89.6% of cases. It was 84.2% for low-grade CINs, 95.8% for high-grade CINs, 31.2% for microinvasive cancers and 81.2% for invasive cancers. No clinical or colposcopic factor could be identified as independent factor associated with the diagnostic agreement with the directed biopsy. Conversely, concordance of biopsy was related to the final diagnosis since the only independent risk factors were a high-grade CIN (adjusted risk ratio (ARR)=1.52, 95% CI=1.11-2.08; p=0.006) and a microinvasive or invasive cancer (ARR=0.56, 95% CI=0.39 0.81; p=0.002).
To ensure that a microinvasive cancer has not been overlooked, the excision of high-grade CINs seems to be justified, whatever the clinical status and the colposcopic aspect.
比较阴道镜引导下活检结果与手术标本分析所确立的最终诊断，并确定活检可靠性所依据的临床和阴道镜因素。
567名女性由同一位阴道镜检查医师诊治，该医师同时进行引导活检和/或宫颈管刮除术。最终组织学诊断显示有29例正常情况（5.2%）、58例低级别宫颈上皮内瘤变（CIN）（10.2%）、448例高级别CIN（79.0%）、16例微浸润癌（2.8%）和16例隐匿性浸润癌（2.8%）。通过单因素和多因素分析研究了年龄、产次、绝经、妊娠、宫颈治疗史、鳞柱交界部位、病变定位、大小和严重程度等多种因素对活检相关性的影响。
399例患者（70.4%）的阴道镜检查结果满意，其中81.2%的病例阴道镜表现与最终组织学诊断一致。活检诊断与最终诊断的总体一致性在89.6%的病例中观察到。低级别CIN为84.2%，高级别CIN为95.8%，微浸润癌为31.2%，浸润癌为81.2%。未发现任何临床或阴道镜因素可被确定为与引导活检诊断一致性相关的独立因素。相反，活检的一致性与最终诊断相关，因为唯一的独立危险因素是高级别CIN（调整风险比（ARR）=1.52，95%置信区间=1.11 - 2.08；p = 0.006）和微浸润或浸润癌（ARR = 0.56，95%置信区间=0.39 - 0.81；p = 0.002）。
为确保未遗漏微浸润癌，无论临床状况和阴道镜表现如何，切除高级别CIN似乎是合理的。
