The Accuracy Of Diagnosing Cervical Intraepithelial Neoplasia With Colposcopically Directed Biopsy Plus Endocervical Curettage.

Objective To evaluate the accuracy of colposcopically directed biopsy plus endocervical curettage(for short: Combination method ) in the diagnosis of cervical intraepithelial neoplasia (CIN).Methods The clinical data of 43 patients with CIN diagnosed by Combination method and than treated with cervical loop electrosurgical procedure (LEEP) shortly after were retrospectively studied in the first peoples hospital of yinchuan between May,2008 and Mar,2010. The consistency of pathological examination between Combination method and LEEP was evaluated. The factors of missed diagnosis of cervical invasive carcinoma were analyzed,such as ages,the grade of CIN,cytological and the positive or negitive of HR-HPV.Results (1)The diagnosis of 31 out of the 43 patients by Combination method was consistent with that by LEEP as confirmed by pathologic diagnosis with a consistence rate of 72.0%.(2) 5 patients were diagnosed CINⅠby Combination method ,2 CINⅡ～Ⅲwere missed,no invasive carcinoma was missed;38 patients were diagnosed CINⅡ～Ⅲby Combination method ,4 invasive carcinoma were missed(4/38,10.5%).(3) The diagnoses of 12 of the 43 patients by Combination method were not consistent with those by LEEP, with an inconsistent rate of 30.2%, including 6 cases of over diagnosis (13.9%, 6/43) and 6 cases of under diagnosis (13.9%, 6/43). Four patients were confirmed as with cervical invasive carcinoma by LEEP/hysterectomy at last with a missed diagnosis rate of 9.3%.(4) The pathologic diagnosis between Combination method and LEEP has no significance in ages between more than 40 and less than 40(χ~2=0.443,P>0.05).(5) The pathologic diagnosis between Combination method and LEEP has no significance in the different grade of CINs (χ~2=0.567,P>0.05).(6) The missed diagnosis rate of invasive carcinoma by colposcopically directed biopsy was significantly higher in the patients with cytologic diagnosis of with≥ASC-H than in the patients cytologiccally diagnosed as with <ASC-H(χ~2=5.983,P<0.05).(7) The pathologic diagnosis between Combination method and LEEP has no significance between HR-HPV positive and HR-HPV negative.Conclusion (1) Combination method diagnosis CIN has benefit of microtrauma and repeatability and low missed features.(2)The accuracy of diagnosing CIN with colposcopically directed biopsy is still unsatisfying. Attention should be paid on the patients with cytological diagnosis of≥ASC-H. so as to avoid missed diagnosis of cervical carcinoma.