阴道镜下活检确诊为 CIN2 的患者在 LEEP 术后发生 病理升级的高危因素分析. (Chinese)

Objective To investigate the risk factors associated with pathological escalation to cervical intraepithelial neoplasia grade 2 (CIN2) or above (CIN2+) in patients with CIN2 confirmed by colposcopic biopsy, aiming to provide evidence for the stratified management of CIN2 patients. Methods Clinical data of 210 patients who underwent LEEP surgery after pathological diagnosis of cervical CIN2 by colposcopic biopsy were retrospectively analyzed. Pathological diagnosis of patients before and after LEEP surgery was observed. The relationship between pathological escalation after LEEP, and age, results of primary liquid-based thin-layer cytology (TCT), typing of high-risk human papillomavirus (HPV), the number of affected quadrants of lesions under colposcopy, the proportion of visible lesion area to cervical surface area, the longest linear length of the lesion, the type of transformation zone (TZ), whether the lesion was involved with glands and the characteristics of colposcopic images was assessed by univariate and multivariate Logistic regression analyses. Results Among 210 cases of cervical CIN2 diagnosed by colposcopic biopsy, 37 cases (17.6%) were pathologically diagnosed with CIN2+ after LEEP, and 1 case was diagnosed with cervical squamous cell carcinoma stage IB1. Univariate analysis showed that pathological escalation after LEEP was associated with the age of patients, the number of affected quadrants of lesions under colposcopy, the proportion of visible lesion area to cervical surface area, the longest linear length of visible lesions, the type of transformation zone, and the characteristics of colposcoic images (all P < 0.05). Multivariate analysis showed that the number (>1) of affected quadrants of lesions under colposcopy, the proportion (≥ 1/3) of visible lesion area to cervical surface area, TZ3 type and the characteristics (≥ 2) of colposcopic images were the high-risk factors for pathological escalation after LEEP (all P < 0.05). For patients aged 26-50 years, the proportion (≥1/3) of lesion area to cervical surface area, TZ3 type and the characteristics (≥2) of colposcopic images were the high-risk factors for pathological escalation after LEEP (all P < 0.05) . Conclusions Colposcopic biopsy may miss the diagnosis of CIN2+ in patients diagnosed with CIN2. The risk of missing the diagnosis of CIN2+ is increased with the increase of the proportion of visible lesion area to cervical surface area (>1/3), the invisibility of the squamous-column junction under colposcopy, and the proportion of grade 2 signs in colposcopic images (≥ 2). For patients with CIN2 who are willing to have children, if they have the above high-risk factors, it is recommended to carefully deliver follow-up observation. [ABSTRACT FROM AUTHOR]

目的  探讨阴道镜下活组织检查 (活检)确诊为宫颈上皮内瘤变 2 级 (CIN2)的患者在宫颈环形电切 术 (LEEP)后病理升级至 CIN2 以上 (CIN2+)的相关风险因素, 为 CIN2 患者的分层管理提供依据。方法  回顾性分 析阴道镜下活检病理诊断宫颈 CIN2 而进一步行 LEEP 术的 210 例患者临床资料, 观察患者在 LEEP 手术前、后的病理 诊断, 采用单因素及多因素 Logistic 回归分析患者年龄、初次液基薄层细胞学检查 (TCT)结果、高危型人乳头瘤病 毒 (HPV)分型、阴道镜下病变累及象限数目、可见病变面积占宫颈表面积的比例、可见病变的最长线性长度、转化 区类型、病变是否累及腺体和阴道镜图像特征等相关因素与 LEEP 术后病理升级的关系。结果  210 例阴道镜下活检 病理诊断的宫颈 CIN2 中, 37 例 (17.6%)LEEP 术后病理诊断为 CIN2+, 其中 1 例为宫颈鳞癌 IB1 期。单因素分析显 示 LEEP 术后病理升级与患者年龄、阴道镜下病变累及象限数目、可见病变面积占宫颈表面积的比例、可见病变的最 长线性长度、转化区类型及阴道镜图像特征有关 (P 均 < 0.05)。多因素分析显示, 阴道镜下病变累及 >1 个象限、可 见病变面积占宫颈表面积的比例≥ 1/3、转化区 3 型及阴道镜图像有 2 种及以上 2 级征象是 LEEP 术后病理升级的高 危因素 (P 均 < 0.05)。对于 26~50 岁的患者, 可见病变面积占宫颈表面积的比例≥ 1/3、转化区 3 型及阴道镜图像 2 种及以上 2 级征象是 LEEP 术后病理升级的高危因素 (P 均 < 0.05)。结论  阴道镜下宫颈活检确诊的 CIN2 中有漏诊 CIN2+ 的情况存在, 随着可见病变面积占宫颈表面积的比例增高 (≥ 1/3)、阴道镜下鳞柱交接部不可见及阴道镜图像 中 2 级征象占比增多 (≥ 2 个), 漏诊 CIN2+ 的风险增加。对于有生育意愿的 CIN2 患者如存在以上高危因素, 建议谨 慎选择随访观察。 [ABSTRACT FROM AUTHOR]

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