15393例宫颈液基细胞学与组织病理学的对照分析

Retrospective analysis of 15 393 cases of liquid-based cervical cytology,with histologic correlation

目的探讨宫颈液基细胞学诊断与组织病理学诊断的符合情况。方法对15 393例做 SurePath 宫颈液基细胞学检查,结果异常者依次做 Hybrid Capture-Ⅱ肿瘤相关人乳头状瘤病毒(HPV)-DNA 检测、5%醋酸宫颈染色肉眼观察并拍照、阴道镜检查及宫颈多点活检行组织病理学检查。细胞学诊断采用 TBS(2001)分级报告系统,阳性诊断包括意义不明的不典型鳞状细胞(ASC-US)以上病变;本组细胞学阳性病例有组织病理诊断结果,并对两者进行了对照分析。结果 15 393例宫颈细胞学检查与组织病理学对照结果显示:7例鳞状细胞癌(SCC)均符合,高级别鳞状上皮内病变(HSIL)为93.6%(103/110)、低级别鳞状上皮内病变(LSIL)为82.0%(443/540)。HPV-DAN 阳性检出率与细胞学 TBS 分级及组织病理学分级正相关。结论应用液基细胞学制片方法、准确掌握 TBS的诊断标准可确保宫颈细胞学检查的准确性。

Objective To study the rate of concordance between positive cervical cytologic interpretation based on liquid-based preparations and subsequent histologic diagnosis. Methods Liquid- based cervical cytology （SurePath） was carried out in 15 393 patients. Cases with the cytologic diagnosis of epithelial cell abnormality were further investigated by human papillomavirus （HPV） DNA testing （ Hybrid Capture Ⅱ ） for the high-risk HPV DNA, colposcopic examination and multiple cervical biopsies. The 2001 version of The Bethesda System for reporting gynecologic cytology was applied. Positive cytologic diagnosis included atypical squamous cells of undetermined significance （ASC-US） or above. Histologic correlation was available in some of the patients. The rate of concordance between positive cytologic interpretation and subsequent histologic diagnosis was calculated. Results Amongst the 15 393 liquid-based cytology cases studied, the cytologic diagnosis of 7 cases squamous cell carcinoma were all concordance with histologic diagnosis, while the rates for high-grade and low-grade squamous intraepithelial lesions were 93.6% （ 103/ 110） and 82. 0% （443/540）, respectively. A positive correlation was also demonstrated between detection of high-risk HPV DNA, positive cytologic interpretation and positive histologic diagnosis. Conclusion Liquid-based cytologic preparation, when coupled with standardized reporting using the Bethesda System 2001, can achieve a high diagnostic accuracy of cervical epithelial abnormalities.