内生型宫颈癌临床误诊原因及防范措施分析OA

Objective To analyze the causes of clinical misdiagnosis of endogenous cervical cancer,and to identify corrective measures,so as to improve the diagnosis and treatment level of clinical physicians.Methods The clinical characteristics,imaging data and pathological characteristics of 3 patients with endogenous cervical cancer misdiagnosed from February 2021 to February 2023 were retrospectively analyzed.Results The clinical manifestations of 3 patients with endogenous cervical cancer were mainly irregular vaginal bleeding(2 patients)and contact bleeding(1 patient).Two cases underwent only routine gynecological examinations without HPV and cytological screening and were misdiagnosed as dysfunctional uterine bleeding.One patient,despite negative results for both cervical liquid-based thin-layer cytology and HPV screening,was misdiagnosed as a Nabothian cyst.The misdiagnosis lasted 4-13 months.Two patients were diagnosed as endocervical-type cervical cancer(squamous cell carcinoma)by colposcopy and multi-site biopsy after they tested positive for HPV16 following ineffective sex hormone therapy.One patient was advised to be followed up,but presented with increased vaginal bleeding afterwards.She was diagnosed with endocervical-type cervical cancer(adenocarcinoma)by repeated hysteroscopy and endocervical curettage.Two patients underwent radical hysterectomy and lymph node dissection,followed by adjuvant radiotherapy and chemotherapy,and remained disease-free for 19 and 24 months,respectively.One patient received chemoradiotherapy due to lymph node metastasis.Conclusion The early signs of endocervical-type cervical cancer are insidious,and insufficient screening and excessive reliance on initial negative test results are the main causes of misdiagnosis.It is necessary to strengthen HPV testing combined with multi-modal examination to reduce the missed diagnosis rate in clinical practice.