对女性3型转变区没有明显病变的宫检查异常的回顾性分析
Jing Yang1, Qiao Liu1, Yi Tang1
1Department of Obstetrics & Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
PeerJ
|December 2, 2025
概括
患有异常子宫部查和3型转变区的妇女需要量身定制的后续检查. 高度细胞学,HPV 16/18与LSIL,或65岁以上的低度细胞学要求立即评估高度状内皮病变 (HSIL+).
科学领域:
- 妇科 妇科 妇科 妇科
- 在瘤学瘤学.
- 公共卫生 公共卫生
背景情况:
- 患有异常宫查和3型转变区 (TZ3) 的女性,由于不可见的状柱状结,会面临临临床挑战.
- 这种解剖特征增加了未检测到的高度宫病变的风险,目前的后续策略缺乏共识.
研究的目的:
- 评估基于风险的管理方法,以对患有异常宫查和TZ3.3的妇女进行评估.
- 在这个人群中确定高度状内皮病变 (HSIL+) 的预测因子和年龄风险值.
主要方法:
- 一项横截面研究分析了4648名患有TZ3的妇女的数据,这些妇女接受了肠镜检查和内宫皮切割 (ECC).
- 使用限制立方线的物流回归用于分析人口统计,细胞学和HPV数据.
主要成果:
- 尽管结肠镜检测结果呈阴性,但3.1%的女性患有HSIL+;可能存在其他未被发现的病例.
- 高等级细胞学 (ASC-H/HSIL/AGC) 始终显示高HSIL+风险 (32.5%-37.2%).
- 在低级细胞学中,HPV 16/18阳性增加了HSIL+风险 (2.4%-5.0%),特别是在LSIL病例中 (5.0%). 年龄≥55岁,低级细胞学和非HPV16/18显示HSIL+风险每年增加10%,65岁以上女性的发病率为4.42%.
结论:
- 基于细胞学,HPV基因型和年龄的风险分层对于管理异常宫查和TZ3.3的妇女至关重要.
- 对于那些高度细胞学,HPV 16/18与LSIL,以及65岁以上的女性低度细胞学和非-16/18HPV的患者,建议立即进行诊断评估.
- 一种定制的,基于风险的方法支持更适当的管理,可能包括对低风险个体进行保守的后续行动.
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