CKC与LEEP术后子宫颈高级别鳞状上皮内病变患者病理检查结果的对比分析

column:Comparative analysis of accuracy and predictability of pathology after CKC and LEEP

摘要:

目的 比较子宫颈冷刀锥切术（CKC）与宫颈环形电切术（LEEP）标本病理检查结果的准确性，以及两者宫颈病变残留预测性的差异。方法 收集2010年7月—2019年9月在漯河市中心医院及无锡市妇幼保健院行CKC或LEEP，且术后3个月内行全子宫切除术的469例宫颈高级别鳞状上皮内病变（HSIL）患者的临床资料。根据手术方式分为CKC组和LEEP组，以子宫切除病理结果为金标准，比较两组的标本切缘病理符合率、病变残留预测值；比较两组标本切缘阳性率、切缘阳性者及阴性者的病变残留率。结果 CKC组切除组织体积平均值大于LEEP组（P <0.05）；CKC组标本切缘阳性率为12.1%（27/223），明显低于LEEP组35.8%（88/246）（P <0.05）；CKC组标本切缘病理符合率为94.2%（210/223），LEEP组标本切缘病理符合率为73.2%（180/246），两者差异无统计学意义（P >0.05）；CKC组标本切缘阳性者的病变残留率为77.8%（21/27），高于LEEP组的38.6%（34/88）（P <0.05）；CKC组标本切缘阴性者的病变残留率为3.6%（7/196），低于LEEP组的7.6%（12/158）（P <0.05）；且两组标本切缘阳性者的病变残留率均明显高于切缘阴性者（二者的R>1，其95%的可信区间不包含1）。CKC组的病变残留阳性预测值为77.8%，阴性预测值为96.4%，敏感性为0.750（95% CI：0.579，0.921），特异性为0.969（95% CI：0.945，0.993），阳性似然比为24.38，阴性似然比为0.26；LEEP组的病变残留阳性预测值为38.6%，阴性预测值为92.4%，敏感性为0.739（95% CI：0.607，0.871），特异性为0.730（95% CI：0.668，0.792），阳性似然比为2.74，阴性似然比为0.36。结论 对于子宫颈高级别鳞状上皮内病变，CKC与LEEP标本切缘阳性均是病变残留的危险因素，CKC标本切缘病理与全子宫标本病理符合率更高，预测病变残留的准确性更好，更加有利于准确指导子宫颈锥切术后的临床处理。

Abstract:

Objective To investigate the accuracy of postoperative pathological results of cervical high grade intraepithelial neoplasia treated by cold scalpel and circular cervical electrotomy.Methods From September 2010 to September 2019, 3-month-after-whole-hysterectomy clinical data of 469 patients admitted to Wuxi Maternal and Child Health Hospital and Luohe Central Hospital with cervical cold knife cut method (CKC) or the cervical cone annular cutting technique (LEEP), with cervical high-grade squamous intraepithelial lesion (HSIL), according to the operation method, were divided into two groups, group CKC and group LEEP. Taking the hysterectomy pathological results as the gold standard, specimens cut edge pathological coincidence rate and residual pathogenesis forecast between two group were compared. The positive rate of incised margin, the positive rate of incised margin, and the negative rate of incised margin were compared between the two groups.Result The average volume of excised tissue in group CKC was larger than that in group LEEP, with statistical significance (P < 0.05). The positive rate of surgical margin of group CKC was 12.1% (27/223), significantly lower than that of group LEEP (35.8% (88/246), with statistically significant difference (P < 0.05). The pathological coincidence rate of specimen incisions in group CKC was 94.2% (210/223), and that in group LEEP was 73.2% (180/246), with no significant difference between two groups (P > 0.05). The pathological residual rate of the patients with positive incisions in group CKC was 77.8% (21/27), higher than 38.6% (34/88) in group LEEP (P < 0.05). In group CKC, the lesion residual rate was 3.6% (7/196), lower than 7.6% (12/158) in group LEEP, with statistically significant difference (P < 0.05). Moreover, the residual rate of lesions in the positive incisor margin of the two groups was significantly higher than that in the negative incisor margin of the two groups (R > 1 for both groups, the 95% confidence interval did not include 1). The positive predictive value of pathological residual in group CKC was 77.8%, the negative predictive value was 96.4%, the sensitivity was 75.0%, the specificity was 96.9%, the positive likelihood ratio was 24.38, and the negative likelihood ratio was 0.26. The positive predictive value of residual pathology in group LEEP was 38.6%, the negative predictive value was 92.4%, the sensitivity was 73.9%, the specificity was 73.0%, the positive likelihood ratio was 2.74, and the negative likelihood ratio was 0.36.Conclusion For the cervical high-grade squamous intraepithelial lesion, CKC and pathological changes of LEEP specimens cut edge positive are residual risk factors. The total postoperative pathological and cutting edge hysterectomy specimen pathological coincidence rate, the accuracy of the prediction residual lesion of CKC are higher than LEEP, of greater value to guidance clinical treatment.