宫颈黏膜鳞状上皮厚度与阴道镜下宫颈病变检查漏诊的关联性分析

Correlation analysis between cervical mucosal squamous epithelial thickness and missed diagnosis of cervical lesions under colposcopy

摘要

目的 探讨宫颈黏膜鳞状上皮厚度与宫颈癌前病变之间的关系,分析宫颈黏膜鳞状上皮厚度与阴道镜下宫颈上皮内瘤变(CIN)3检查漏诊的关联性。方法 回顾性收集2014年1月至2021年7月于保定市第一中心医院做阴道镜下检查且进一步行宫颈锥切术425例患者的临床资料,调取病理切片787张,按照正常宫颈黏膜鳞状上皮(n=208)及CIN1(n=161)、CIN2(n=190)、CIN3(n=228)进行分组,比较不同组别病理特征之间宫颈黏膜鳞状上皮厚度的差异;对CIN3组的228例切片以阴道镜下检查情况分为漏诊组(n=128)与未漏诊组(n=100),分析不同组别之间阴道镜下检查CIN3上皮厚度的差异;对比阴道镜下检查病理结果与宫颈锥切术病理结果,分析宫颈黏膜鳞状上皮厚度与阴道镜下宫颈病变检查漏诊的关联性。结果 正常宫颈黏膜组、CIN1组、CIN2组、CIN3组的宫颈黏膜鳞状上皮厚度和细胞层数比较,差异均有统计学意义(F值分别为13.140、9.530,P<0.05).在正常宫颈黏膜组中,绝经后宫颈黏膜鳞状上皮厚度比绝经前明显变薄,经比较差异有统计学意义(t=3.553,P<0.05);在CIN1组、CIN2组、CIN3组中,在>50岁者宫颈黏膜鳞状上皮厚度比≤50岁者均明显变薄(t值分别为2.564、2.930、2.480),绝经后宫颈黏膜鳞状上皮厚度比绝经前均明显变薄(t值分别为2.496、2.563、3.486),经比较差异均有统计学意义(P<0.05).对阴道镜下检查病理结果为CIN3的病理资料与宫颈锥切术后病理结果比较显示,有100例CIN3发生漏诊,漏诊率为43.86%;检查漏诊组的病理切片宫颈黏膜鳞状上皮厚度明显薄于未漏诊组,经比较差异有统计学意义(t=10.573,P<0.05)。结论 CIN3上皮厚度比正常宫颈黏膜鳞状上皮、CIN1、CIN2均明显变薄;患者的年龄、绝经对CIN上皮厚度均存在影响;对CIN3患者进行阴道镜下检查,宫颈黏膜鳞状上皮较薄的患者在阴道镜下病变不典型,容易造成漏诊.

Abstract

Objective To explore the relationship between cervical mucosal squamous epithelial thickness and cervical precancerous lesions, and to analyze the association between cervical mucosal squamous epithelial thickness and colposcopic cervical intraepithelial neoplasia (CIN) 3 examination. Methods The clinical data of 425 patients who underwent colposcopy and further cervical conization were collected from January 2014 to July 2021 in Baoding First Central Hospital, and 787 pathological sections were collected, and the differences in the thickness of the squamous epithelium of the cervical mucosa between different groups were compared according to the normal cervical mucosal squamous epithelium (n=208) and CIN1 (n=161), CIN2 (n=190), and CIN3 (n=228). The 228 sections in the CIN3 group were divided into missed group (n=128) and non-missed group (n=100) according to colposcopy, and the differences in CIN3 epithelial thickness were analyzed between different groups. The pathological results of colposcopy were compared with the pathological results of cervical conization, and the association between the thickness of the squamous epithelium of the cervical mucosa and the missed diagnosis of cervical lesions was analyzed. Results There were significant differences in the thickness of the squamous epithelium and the number of cell layers of the cervical mucosa in the normal cervical mucosa group, CIN1 group, CIN2 group, and CIN3 group (F values were 13.140, 9.530, P<0.05, respectively). In the normal cervical mucosa group, the squamous epithelial thickness of the cervical mucosa after menopause was significantly thinner than that before menopause, and the difference was statistically significant (t=3.553, P<0.05). In the CIN1 group, CIN2 group, and CIN3 group, the squamous epithelial thickness of the cervical mucosa was significantly thinner in the >50-year-old group than in the ≤50-year-old group (t-values: 2.564, 2.930, and 2.480, respectively), and the thickness of the squamous epithelium of the cervical mucosa after menopause was significantly thinner than that before menopause (t-values: 2.496, 2.563, 3.486), and the differences were statistically significant (P<0.05). The pathological data of CIN3 on colposcopy were compared with the pathological results after cervical conization, and 100 cases of CIN3 were missed, with a missed diagnosis rate of 43.86%. The squamous epithelium thickness of the cervical mucosa in the pathological section of the missed group was significantly thinner than that in the non-missed group, and the difference was statistically significant (t=10.573, P<0.05). Conclusion The epithelial thickness of CIN3 was significantly thinner than that of normal cervical mucosal squamous epithelium, CIN1 and CIN2. The age and menopause of the patients had an effect on the epithelial thickness of the CIN. Colposcopy of CIN3 patients showed that patients with thin squamous epithelium of the cervical mucosa had atypical colposcopic lesions, which was easy to cause missed diagnosis.

关键词

宫颈黏膜鳞状上皮厚度 / 宫颈鳞状上皮内病变 / 阴道镜检查 / 宫颈锥切术 / 漏诊

Key words

cervical mucosal squamous epithelial thickness / squamous intraepithelial lesions of the cervix / colposcopy / cervical conization / missed diagnosis

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基金资助

保定市科技计划项目(2241ZF044)