液基细胞学检测及阴道镜检查诊断宫颈病变的临床意义

Clinical Value of Liquid Based Cytology Test in Comparison with Vaginoscopy Histology in the Diagnosis of Cervical Lesions

目的：探讨液基细胞学检测与阴道镜活检和病理学诊断在宫颈病变诊断中的临床意义。方法：采用膜式超薄液晶细胞学检测系统（TCT）收集宫颈抹片6621例检测,报告结果使用TBS分类系统,其中细胞学筛查为异常结果共253例,对其行阴道镜检查及病理检查。结果：细胞学检查ASC-US（意义不明的不典型鳞状细胞）共180例,病理结果其中CINⅠ（宫颈上皮内瘤样病变-轻度）37例,CINⅡ（宫颈上皮内瘤样病变-中度）13例,CINⅢ（宫颈上皮内瘤样病变-重度）1例,鳞癌4例。细胞学显示AGUS（意义不明的不典型腺细胞）共7例,其中病理结果证实CINⅠ1例。细胞学显示LSIL（低度鳞状上皮内病变）共46例,其中病理结果证实CINⅠ18例,CINⅡ1例,CINⅢ1例,浸润鳞癌2例。细胞学显示ASC-H（高度鳞状上皮病变不典型鳞状细胞）共17例,其中病理结果证实CINⅡ2例,CINⅢ3例,鳞癌2例,原位癌2例。细胞学显示HSIL（高度鳞状上皮内病变）共3例,均经病理结果证实为癌,其中2例为浸润性鳞癌,1例为高分化腺癌。结论：1）应用TCT辅助阴道镜检查可提高宫颈癌前病变和癌变的检出率。2）单纯TCT检查不能诊断宫颈癌,只有病理学检查才能明确诊断。3）在临床中ASC-US可于3～6个月后复查,而本研究显示及时行阴道镜下活检可尽早诊断宫颈癌,争取手术时机。

Objective To study the clinical value of liquid based cytology test compared with vaginoscopy histology in the diagnosis of cervical lesion. Methods Retrospective analysis was carried out in 6 621 females（ age range from 21 to 73 years old） from a single centre（ Beijing Friendship Hospital） admitted from May, 2006 to October, 2006. All the patients received liquid based cytology test （Thin Prep Pap Test, TCT） and the result was reported in terms of the Bethesda system（ TBS system）. Among all the patients, 253 of them were diagnosed as atypical squamous cells of undetermined significance（ASC-US） or above and should receive further vaginoscopy biopsy test. Results Among the 253 patients with abnormal TCT results, 180 cases were diagnosed as ASC-US, 7 cases as atypical gland cells of undetermined significance（ AGUS）, 46 cases as low grade squamous intraepithelial lesions（ LSIL）, 17 cases as atypical squamous cells cannot exclude high grade intraepithelial lesion（ASC-H） and 3 cases as high grade squamous intraepithelial lesions（HSIL）. All the TCT results of the above 253 patients were compared with the histological results from vaginoscopy biopsy. 1 ） Among the 180 ASC-S cases, after biopsy test, 37 cases were diagnosed as stage one cervical intraepithelial neoplasia（ CIN Ⅰ ）, 13 cases as CIN Ⅱ and 1 case as CIN Ⅲ. 2） Among the 7 cases of AGUS, one case was confirmed as CIN Ⅰ after biopsy. 3 ） Among the 46 cases of LSIL, further biopsy test showed that 18 cases of them were CIN Ⅰ , 1 case was CIN Ⅱ , 1 case was CIN Ⅲ and 2 cases were invasive squamous cancer. 4） Among the 17 cases of ASC-H, 2 cases were diagnosed as CIN Ⅱ , 3 cases as CIN Ⅲ and 2 cases of in-situ squamous cancer after biopsy. 5 ） All the 3 cases who were diagnosed as HSIL by TCT were confirmed to have cancer after histological exam by vaginoscopy biopsy. Two of them were invasive squamous cancer and the other one was well-differentiated adenocarcinoma. Human papilloma virus （HPV） DNA was detected in both samples obtained by the 2 methods of TCT and vaginoscopy biopsy. Sixty patients showed HPV-DNA positive from TCT（27.7% ） but 82 patients showed HPV-DNA positive from the biopsy（32.4% ）. The positive screening rate of HPV by the above 2 methods was compared by means of ）x^2 exam and statistical difference was found between the 2 methods （ P = 0. 03 ）. Conclusion Adjunctive TCT can enhance the sensitivity and accuracy of the diagnosis of cervical leision by vaginoscopy and biopsy. In clinical practice, ASCUS usually need to recheck after 3 ～ 6 months. However this reseach shows ： that carrying out vaginoscopy and biopsy as early as possible can earn much opportunity to diagnose cervical cancer early.