76例CIN及宫颈癌临床、病理及影像分析(1)
[摘要] 目的 分析CIN及宫颈癌的临床、病理学特征及影像表现。 方法 回顾性分析2015年1月—2016年12月该院收治的76例CIN及宫颈癌患者的资料。76例中22例曾行常规MRI平扫及DWI扫描。重点分析临床表现、HPV检测阳性率、病理分型及免疫组化表达阳性率、MRI分期。 结果 患者年龄30～86岁，平均(51.16±2.03)岁。主要临床表现：白带增多、阴道接触性或不规则出血等。HPV 检测阳性73例(96%)。病理采取液基薄层细胞学检查(TCT)，病理类型：CINⅡ级 8例，Ⅱ～Ⅲ级7例，Ⅲ级20 例，浸润癌41例(鳞癌32例，腺癌9例)。CINⅡ级、Ⅲ在≤45岁中最多(15/35，42.9%)。P63、ki67在CINⅡ级 、Ⅱ～Ⅲ级、Ⅲ级、鳞癌及腺癌的阳性率分别为42%、57%、80%、100%及43%、59%、83%、100%。该组MRI平扫结合DWI序列对19例宫颈癌进行FIGO准确分期，准确性为86.4%(19/22)。 结论 CIN及宫颈癌多见于中老年妇女，其HPV感染率较高。病理类型以CINⅡ级 、Ⅲ级及鳞癌多见，免疫组织化学P63、ki67在浸润癌中的表达率较高，MRI及DWI可较为准确分期。
[关键词] 宫颈癌；临床病理；免疫组织化学；磁共振成像；诊断
[中图分类号] R737 [文献标识码] A [文章编号] 1674-0742(2017)12(a)-0022-05
[Abstract] Objective To analyze the clinical， pathological and imaging features of CIN and cervical carcinoma. Methods The data of 76 cases with CIN and cervical carcinoma admitted and treated in our hospital from January 2015 to December 2016 were reviewed， including 22 cases who had underwent MRI plain scan and DWI scan ever， and the clinical manifestations， HPV test positive rate， pathological typing， immunohistochemical expression positive rate and MRI stage were analyzed. Results The ages of patients were from 30 to 86 years old，(51.16±2.03)years old on average， and the major clinical manifestations were leukorrhagia， vaginal contact or irregular bleeding， and the 73 cased were tested positive(96%)， and the TCT showed that the pathological type was that CINⅡ in 8 cases， Ⅱ～Ⅲ in 7 cases and Ⅲ in 20 cases， 41 cases with infiltrating carcinoma ( 32 cases with squamous carcinoma， 9 cases with adenocarcinoma)， CINⅡ and CINⅢ were the most during patients ≤45 years old (15/35，42.9%)， and the positive rates of P63 and ki67 in the CINⅡ， Ⅱ～Ⅲ， Ⅲ， squamous carcinoma and adenocarcinoma were respectively 42%， 57%， 80%， 100%， 43%， 59%， 83%， 100%， and the accurate rate of MRI plain scan and DWI sequence for FIGO accurate stage of 19 cases with cervical carcinoma was 86.4% (19/22). Conclusion CIN and cervical carcinoma are mostly seen in middle-aged and senile women， and the infection rate of HPV is higher， and the pathological types are mostly CINⅡ， Ⅲ and squamous carcinoma， and the expression rate of immunohistochemistry P63 and ki67 in the infiltrating carcinoma is higher， and MRI and DWI can have an accurate stage.
[Key words] Cervical carcinoma； Clinical pathology； Immunohistochemistry； MRI； Diagnosis
宮颈癌(cervical cancer)是较为常见的恶性肿瘤，发病率及病死率分别居妇科恶性肿瘤第3位及第4位[1]。人乳头状病毒(human papillomavirus，HPV)感染被公认为该症发病的最主要原因[1]。目前广泛使用的宫颈病变的三级分类系统(即CIN1、CIN2、CIN3)，CIN1多为致癌性或非致癌性HPV 感染的组织病理学表现，临床上以随访为主；HCIN2、CIN3多被认为是癌前病变，需手术治疗[2]。宫颈癌的细胞学检测为传统而经典的特异性检测方法，但敏感性相对较低，对阅片者水平要求较高，与HPV联合成为宫颈癌较佳的筛查方案，敏感性得以提高。研究提示HPVl6、18是与宫颈癌关系最密切的两种亚型，在宫颈癌中检出率分别为50%～60%及10%～15%[3]。HPV检测与细胞学检测相结合，在宫颈癌诊治中具有低成本高效益[4]。经阴道彩色多普勒超声(TVCDS)及MRI等影像学检查手段可在肿瘤累及范围、周围浸润及淋巴结转移等方面弥补阴道镜及术前病理检查的不足，以协助术前评估分期及进一步治疗方案的制定[5]。该文回顾性分析2015年1月—2016年12月该院收治的76例CIN及宫颈癌患者的资料，旨在探讨CIN及宫颈癌的临床、病理学特征及影像表现学表现特征，以期提高认识，现报道如下。, 百拇医药(任萍 丁长青 王雪璐)
[关键词] 宫颈癌；临床病理；免疫组织化学；磁共振成像；诊断
[中图分类号] R737 [文献标识码] A [文章编号] 1674-0742(2017)12(a)-0022-05
[Abstract] Objective To analyze the clinical， pathological and imaging features of CIN and cervical carcinoma. Methods The data of 76 cases with CIN and cervical carcinoma admitted and treated in our hospital from January 2015 to December 2016 were reviewed， including 22 cases who had underwent MRI plain scan and DWI scan ever， and the clinical manifestations， HPV test positive rate， pathological typing， immunohistochemical expression positive rate and MRI stage were analyzed. Results The ages of patients were from 30 to 86 years old，(51.16±2.03)years old on average， and the major clinical manifestations were leukorrhagia， vaginal contact or irregular bleeding， and the 73 cased were tested positive(96%)， and the TCT showed that the pathological type was that CINⅡ in 8 cases， Ⅱ～Ⅲ in 7 cases and Ⅲ in 20 cases， 41 cases with infiltrating carcinoma ( 32 cases with squamous carcinoma， 9 cases with adenocarcinoma)， CINⅡ and CINⅢ were the most during patients ≤45 years old (15/35，42.9%)， and the positive rates of P63 and ki67 in the CINⅡ， Ⅱ～Ⅲ， Ⅲ， squamous carcinoma and adenocarcinoma were respectively 42%， 57%， 80%， 100%， 43%， 59%， 83%， 100%， and the accurate rate of MRI plain scan and DWI sequence for FIGO accurate stage of 19 cases with cervical carcinoma was 86.4% (19/22). Conclusion CIN and cervical carcinoma are mostly seen in middle-aged and senile women， and the infection rate of HPV is higher， and the pathological types are mostly CINⅡ， Ⅲ and squamous carcinoma， and the expression rate of immunohistochemistry P63 and ki67 in the infiltrating carcinoma is higher， and MRI and DWI can have an accurate stage.
[Key words] Cervical carcinoma； Clinical pathology； Immunohistochemistry； MRI； Diagnosis
宮颈癌(cervical cancer)是较为常见的恶性肿瘤，发病率及病死率分别居妇科恶性肿瘤第3位及第4位[1]。人乳头状病毒(human papillomavirus，HPV)感染被公认为该症发病的最主要原因[1]。目前广泛使用的宫颈病变的三级分类系统(即CIN1、CIN2、CIN3)，CIN1多为致癌性或非致癌性HPV 感染的组织病理学表现，临床上以随访为主；HCIN2、CIN3多被认为是癌前病变，需手术治疗[2]。宫颈癌的细胞学检测为传统而经典的特异性检测方法，但敏感性相对较低，对阅片者水平要求较高，与HPV联合成为宫颈癌较佳的筛查方案，敏感性得以提高。研究提示HPVl6、18是与宫颈癌关系最密切的两种亚型，在宫颈癌中检出率分别为50%～60%及10%～15%[3]。HPV检测与细胞学检测相结合，在宫颈癌诊治中具有低成本高效益[4]。经阴道彩色多普勒超声(TVCDS)及MRI等影像学检查手段可在肿瘤累及范围、周围浸润及淋巴结转移等方面弥补阴道镜及术前病理检查的不足，以协助术前评估分期及进一步治疗方案的制定[5]。该文回顾性分析2015年1月—2016年12月该院收治的76例CIN及宫颈癌患者的资料，旨在探讨CIN及宫颈癌的临床、病理学特征及影像表现学表现特征，以期提高认识，现报道如下。, 百拇医药(任萍 丁长青 王雪璐)