宫颈管诊刮术在宫颈癌及癌前病变诊断中的价值

摘要

目的：探讨宫颈管诊刮术（ ECC）在诊断宫颈癌及宫颈癌前病变中的价值，以及阴道镜检查不满意时常规行ECC的必要性。方法普查对象共1671人，均接受叶酸受体介导的亚甲蓝染色（ FRD）及宫颈薄层液基细胞学检查（ TCT），并均行阴道镜检查及宫颈活检，阴道镜检查不满意者同时行宫颈管诊刮术。分析总人群、FRD及TCT筛查阳性人群、≥宫颈上皮内瘤变2级（ CINⅡ）人群及不同年龄段人群的不满意阴道镜率。比较宫颈活检和ECC对阴道镜不满意人群中≥CIN2病变的诊断价值。结果①所有筛查对象中，不满意阴道镜率为25．0％（418／1671）；FRD和TCT筛查阳性人群不满意阴道镜率为22．3％（116／520）；≥CIN2病变人群不满意阴道镜率为10．8％（12／111）。30～40岁人群不满意阴道镜率为11．4％（85／743 ），41～50岁人群为26．6％（166／625 ），51～60岁人群为55．1％（167／303）。②阴道镜检查不满意人群ECC诊断准确率（100％）高于宫颈活检（33．3％，P＜0．01）。结论由于阴道镜检查不满意人群的存在，阴道镜指导下的宫颈活检对宫颈癌及癌前病变的诊断存在一定的漏诊率，宫颈癌筛查阳性且阴道镜检查不满意者需常规行 ECC以保证病理标本取材的全面性。%Objective To assess the application of endocervical curettage (ECC) in the diagnose of cervical cancer and cervical intraepithelial neoplasia ( CIN) and the necessity of ECC when colposcopic examination was unsatisfactory . Methods A total of 1 671 women were enrolled into the current study where they were subject to folate receptor -media-ted diagnosis (FRD) using methylene blue dye and thin cytologic test (TCT), in addition to colposcopy and cervical bi-opsies.For those not satisfied with colposcopic examination , endocervical curettage was performed .Then, the unsatisfac-tory rates of colposcopy were analyzed among general population , women showing positive results in FRD and TCT tests , those with high-grade cervical intraepithelial neoplasia ( CIN grade 2 or higher ) , and different age groups .Results The unsatisfactory rate of colposcopy was 25.0%(418/1 671) for all the participants, 22.3%(116/520) for those show-ing positive results in FRD and TCT tests , and 10.8%(12/111) for those with high-grade CIN.The unsatisfactory rate of colposcopy was 11.4%(85/743) for women aged 30-40, 26.6%(166/625) for those aged 41-50 and 55.1%(167/303) for those aged 51-60.For women unsatisfied with colposcopy examination , ECC was superior to cervical biopsy due to its higher rate of correct diagnosis (100%vs.33.3%, P<0.01).Conclusion Possibilities exist that cervical cancer and CIN may not be diagnosed through colposcopy with respect to some patients who were unsatisfied with such an examina -tion.Therefore, ECC is suggested to be performed routinely to ensure that pathological specimens have been comprehensive -ly collected from those showing positive results in FRD and TCT tests who were not satisfied with colposcopy .