摘要
目的:通过对比阴道镜下活检病理、宫颈锥切术中冰冻病理与术后石蜡病理(paraffin section examination,PSE)的一致性,对高级别宫颈上皮内瘤变行子宫切除术的术前病理确诊方式进行研究。方法:选取2010年1月至2015年12月阴道镜活检病理为宫颈上皮内瘤变Ⅱ级(CINⅡ)和Ⅲ级(CINⅢ、原位癌)在我院行宫颈锥切术患者共454例,其中依宫颈锥切术中冰冻病理即刻行子宫切除手术治疗患者238例,另外216例为待宫颈锥切术后石蜡病理回报后再次子宫切除手术治疗的患者,对比阴道镜下活检病理、宫颈锥切术中冰冻病理与术后石蜡病理的一致性,以及对比锥切术后石蜡病理与再次子宫切除术后病理的一致性。结果:阴道镜活检与术中冰冻病理诊断的符合率为89. 11%(270/303),CINⅡ为63. 33%(38/60),22例升级为CINⅢ; CINⅢ为95. 47%(232/243),11例升级(9例升级为宫颈癌Ⅰ_(a1)期,2例升级为Ⅰb1期)。阴道镜活检与术后石蜡病理诊断的符合率为77. 53%(352/454)。CINⅡ为22. 99%(20/87),67例升级(57例升级为CINⅢ,8例升级为宫颈癌Ⅰ_(a1)期,2例升级为Ⅰa2期); CINⅢ为90. 46%(332/367),35例升级(26例升级为宫颈癌Ⅰ_(a1)期,7例升级为Ⅰb1期,2例升级为Ⅱa期)。阴道镜活检对宫颈癌的漏诊率总体为9. 91%(45/454)。宫颈锥切术中同时送冰冻病理患者303例,宫颈锥切术中冰冻病理与术后石蜡病理诊断的符合率为88. 12%(267/303)。CINⅡ为60. 00%(36/60),24例升级(18例升级为CINⅢ,5例升级为宫颈癌Ⅰ_(a1)期,1例升级为Ⅰa2期); CINⅢ为95. 06%(231/243),12例升级(9例升级为宫颈癌Ⅰ_(a1)期,2例升级为Ⅰb1期,1例升级为Ⅱa期)。宫颈锥切术中冰冻病理对宫颈癌的漏诊率总体为5. 94%(18/303)。宫颈锥切术中同时送冰冻病理患者303例,宫颈锥切术术中冰冻病理比阴道镜活检病理诊断的符合率高,差异有统计学意义(χ2=27. 68,P﹤0. 05)。待宫颈锥切术后石蜡病理回报后�
Objective ： A comparative analysis was carried out by the pathological results of colposcopy biopsy, intr-aoperative frozen section pathology and consistency paraffin section examination （ PSE ） of cervical eonization speci-mens to study the preoperative pathological diagnosis of high grade cervical intraepithelial neoplasia before hysterecto-my. Methods ： A retrospective study was carried out in 454 eases with CIN Ⅱ - Ⅲ underwent eolposeopy biopsy then eonization of cervix, between January 2010 and December 2015 in our hospital,238 eases of patients were treated with frozen pathology imnlediately after cervix eonization. In addition, 216 eases of the patients were reoperated after the cervical eonization, by contrast eolposeopy biopsy, intraoperative frozen section pathology and consistency paraffin sec-tion examination of cervical eonization specimens and by contrast the consistency of pathology after cervical eonization and hysterectomy. Results ： The diagnosis coincidence rate of colposcopy biopsy and intraoperative frozen section pathology was 89.11% （270/303）, CIN Ⅱ was 63.33 % （ 38/60）, 22 eases were upgraded to CIN Ⅲ. CIN Ⅲ was 95.47 % （232/243） ,11 eases were upgraded （9 eases were upgraded to Ⅰal ,2 eases were upgraded to Ⅰb1 ）. The coinci-dence rate between the biopsy of the colposcopy and the pathological diagnosis of paraffin was 77.53% （352/454）. CIN Ⅱ was 22.99% （20/87）,67 eases were upgraded （57 eases were upgraded to CINⅢ,8 eases were upgraded to cervical cancer stage Ⅰa1,2 eases were upgraded to Ⅰa2 stage） , CIN Ⅲ was 90.46% （332/367） ,35 eases were up-graded （26 eases were upgraded to cervical cancer Ⅰa1 stage,7 eases were upgraded to Ⅰb1 stage,2 eases were up-graded to Ⅱa stage）. The total missed diagnosis rate of colposcopy biopsy to cervical cancer was 9.91% （45/454）. 303 eases of frozen histopathologieal patients in cervical eonization, the coincidence rate between frozen pathology and paraffin pathological diag
作者
郝真
赵万成
杨清
Hao Zhen;Zhao Wancheng;Yang Qing(Department of Obstetrics and Gynecology,Shengjing Hospital,China Medical University,Liaoning Shenyang 110004,China.)
出处
《现代肿瘤医学》
CAS
2018年第20期3276-3281,共6页
Journal of Modern Oncology
基金
辽宁省卵巢恶性肿瘤病例信息平台的建立及诊治技术规范化推广项目(编号:LNCCC-A01-2015)
沈阳市科技计划项目(编号:17-230-9-10)
关键词
高级别宫颈上皮内瘤变
宫颈锥切术
阴道镜活检
冰冻病理
石蜡病理
high grade cervical intraepithelial neoplasia
conization of cervix
colposcopy biopsy
rozen section examination
paraffin section examination
