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目的评估阴道镜下活检诊断宫颈上皮内瘤样病变(cervical inteaepithelial neoplasia,CIN)的临床价值,分析漏诊相关因素。方法回顾性分析2012年3月—2015年3月收治的经阴道镜下活检诊断为CIN的160例患者的临床资料,所有患者均在近期内接受宫颈锥切术治疗,以病理结果作为金标准,评估阴道镜下活检诊断CIN的准确性,分析漏诊相关因素。计数资料采用χ2检验,影响因素分析采用Logistics回归分析,P<0.05为差异有统计学意义。结果 160例患者经术后病理证实为CINⅠ级46例,CINⅡ~Ⅲ级101例,宫颈浸润癌13例,阴道镜活检与病理诊断符合率为91.9%,其中漏诊宫颈浸润癌13例,漏诊率为8.1%。细胞学结果(OR=8.162,95%CI为3.162~16.987)、阴道镜图像质量(OR=4.364,95%CI为1.122~8.621)、活检标本数量(OR=5.214,95%CI为1.416~10.562)、宫颈病变面积(OR=4.416,95%CI为1.126~9.687)均为阴道镜下活检漏诊宫颈浸润癌的独立因素。结论阴道镜下活检对宫颈病变诊断有其直观性优势,但对宫颈上皮瘤样病变诊断尚存在缺陷,同时对宫颈癌漏诊率较高,而细胞学结果、阴道镜图像质量、活检标本数量及宫颈病变面积均是影响其诊断宫颈癌准确性的相关因素。
Objective To evaluate the clinical value of colposcopic biopsy in the diagnosis of cervical intraepithelial neoplasia (CIN) and analyze the related factors of missed diagnosis. Methods The clinical data of 160 patients with CIN who underwent colposcopy biopsy from March 2012 to March 2015 were retrospectively analyzed. All patients underwent cervical conization in the near future. The pathological results were taken as the gold standard , Assess the accuracy of colposcopy biopsy diagnosis of CIN, analysis of misdiagnosis related factors. Counting data using χ2 test, the impact of factor analysis using Logistics regression analysis, P <0.05 for the difference was statistically significant. Results The pathological findings of 160 patients were 46 cases of CINⅠ, 101 cases of CINⅡ ~ Ⅲ and 13 cases of invasive cervical carcinoma. The coincidence rate of colposcopy biopsy and pathological diagnosis was 91.9%, of which 13 cases were missed by invasive cervical cancer, and the misdiagnosis rate 8.1%. Cytology results (OR = 8.162, 95% CI: 3.162-16.987), colposcopy image quality (OR = 4.364, 95% CI: 1.122-8.621), biopsy specimens (OR = 5.214, 95% CI 1.416-10.562 ), Cervical lesions area (OR = 4.416, 95% CI 1.126 ~ 9.687) were independent factors of missed diagnosis of cervical invasive carcinoma by colposcopy biopsy. Conclusions Colposcopy biopsy has its advantages in the diagnosis of cervical lesions. However, the diagnosis of cervical epithelial neoplasia is still deficient and the rate of misdiagnosis of cervical cancer is high. The results of cytology, the colposcopy image quality, the number of biopsy specimens, Cervical lesions area are related to the accuracy of its diagnosis of cervical cancer-related factors.