何晓明 1尤志学 2朱岩 3吴敏霞 1王荣敏 4邢燕 2周斌兵2
作者信息
- 1. 南京医科大学第一临床医学院妇产科，南京 210029
- 2. 南京医科大学第一附属医院 妇科，南京 210029
- 3. 南京医科大学第一附属医院 病理科，南京 210029
- 4. 复旦大学附属上海红房子医院，上海 200000
- 折叠
摘要
Abstract
Objective:To evaluate the accuracy of colposcopy-guided biopsy in diagno-sis of CINII and the factors of missed CINII+ and to analyze the predictive values of P16 INK4a protein for the missed CINII+. Methods:A retrospective study was performed on 148 cases with diagnosis of CINII in the colposcopy guided biopsy and treated by LEEP later at the Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, be-tween Dec. 2013 and July 2015. In order to analyze the relationship between missing diagnosis of CINII+ with clinical biologic factors,including age of the patient,cervical cytology before col-poscopy,loads of HR-HPV,the quadrants of the cervical surface at the colposcopy evaluation, different types of cervical transformation zone,the feature of colposcopic impression and P16INK4a protein testing result in biopsy,by comparing the histopathologic diagnosis between colposcopy-guided biopsy and cone specimen. Patients were separated according to LEEP pathology (≤CI-NII vs >CINII) .χ2 tests was used to compare the different frequencies of factors in two groups, then 7 factors with the missed CINII+were processed into binary logistic regression analysis. Re-sult:(1) Among the 148 cases with CINII diagnosed by colposcopy-directed biopsy,71 cases ( 49 . 97%) were missed diagnosis of CINII+. One patient was diagnosed cervical squamous car-cinoma(IA1),another one was diagnosed cervical squamous carcinoma(IB1) in cone speci-men. Univariate analysis showed that age of the patient, cervical cytology before colposcopy, loads of HR-HPV,the quadrants of the cervical surface at the colposcopy evaluation,different types of cervical transformation zone and the feature of colposcopic impression were not risk fac-tors of missed diagnosis of CINII+(all P>0. 05) except for the expression of P16INK4a protein in biopsy (P<0. 05). Multivariable analysis found that P16INK4a protein positive was associated with missed diagnosis of CINII+(OR=9. 846,95%CI:2. 165~44. 787;P=0. 003). (2)All the colposcopically direated biopsy were accepted immunohistochemical detection the expression of P16INK4a protein. The result showed that 21 cases (15. 32%) were negative and 127 cases (84. 68%) were positive. Among the 21 cases with P16INK4a protein negative,3 case(14. 29%) were missed diagnosis of CINII+,while 68 case(53. 54%) with P16INK4a protein positive were missed. In which there were significant difference (P<0. 05). The sensitivity was 95. 77%,the specificity was 23. 38%,the positive predictive value was 83. 71% and the negative predictive value was 53. 54% for missed CINII+ of P16INK4a protein staining. Conclusions:There were missed diagnosis of CINII+in CINII diagnosed by colposcopically directed biopsy. Immunostain-ing of P16 INK4a protein as the risk factors of missed diagnosis of CINII+,It is reasonable to take immediate treatment for patients who diagnosed CINII in biopsy with P16INK4a protein positive. The decision of treatment or observation for CINII will require individualization by considering patients' age,P16INK4a protein expression in biopsy,protection of fertility and follow-up compli-ance.关键词
CINII/阴道镜/宫颈环形电切术/活检/P16 INK4a蛋白Key words
Cervical intraepithelial neoplasia II/Colposcopy/LEEP/Biopsy/P16 INK4a protein分类
医药卫生
