TCT联合阴道镜在宫颈疾病中的诊断价值

Diagnostic Performance of TCT Combined with Colposcopy for Cervical Diseases

目的探讨液基薄层细胞检测系统(TCT)联合阴道镜及阴道镜下宫颈活检在宫颈疾病中的诊断价值。方法回顾性分析2006年1月至2007年12月来我院门诊主诉白带增多、性交出血及妇检宫颈糜烂的756例患者行TCT筛查,其中125例阳性患者进行阴道镜下宫颈活检情况。结果TCT异常率为16.53%,TCT检查CINⅠ及以上病例诊断与病理活检诊断符合率为83.10%、灵敏度为86.44%(51/59)、特异性为88.10%(74/84)、阳性预测值83.61%(51/61)、阴性预测值90.24%(74/82);阴道镜检查CINⅠ及以上病例诊断与病理活检诊断符合率为71.43%、灵敏度为95.45%(63/66)、特异性为86.05%(74/86)、阳性预测值84.00%(63/75)、阴性预测值96.10%(74/77);TCT检查2例宫颈癌,而阴道镜和病理活检均诊断3例宫颈癌,提示阴道镜检查宫颈癌的诊断价值高于TCT。结论TCT细胞涂片联合阴道镜下活检病理组织学检查可明显提高CIN的阳性检出率,是发现宫颈疾病安全、方便、准确、可靠的检查方法,适合作为CIN的筛查方法。

Objective The objectives of this study was to establish whether combined liquid-based thin-layer cells Detection System （TCT） with colposcopy inspection and the cervical biopsies taken with colposcopy improves the detection of cervical diseases. Methods A total of 756 outpatients who complained leukorrhagia, sexual intercourse bleeding and diagnosed cervical erosion after visual inspection at our hospital between January 2006 to December 2007 were analyzed retrospectively. All women underwent TCT examination, and 125 positive cases had colposcopy examination and biopsies. The accuracy of the combined test compared with TCT alone or colposcopy alone was evaluated using likelihood ratios. Results The accuracy of TCT is 83.10%. The estimated sensitivity, specificity, the positive likelihood ratios and the negative likelihood ratios were 86.44%（51/59）, 88.10%（74/84）, 83.61%（51/61） and 90.24%（74/ 82）, respectively for TCT when used for diagnosis of CIN 1-3 lesions and cancer; and were 95.45%（63/66）, 86.05% （74/86）, 84.00% （63/75） and 96.10% （74/77）, respectively for colposcopy examination. The coincidental rate of TCT compared with pathology is 83.1%, and is 71.43% compared with colposcopy examination. TCT examination diagnosed 2 patients with cervical cancer. One more patient was diagnosed cervical cancer when examined with colposcopy and pathological biopsy, which suggests that colposcopy has higher diagnostic performance than TCT. Conclusion TCT cell smear combined with histological biopsy taken by colposcopy can significantly increase the positive diagnosis rate of CIN lesions. This combined examination is considered as a safe, convenient, accurate and reliable method for the detection of cervical diseases. It can be used as screening method for CIN lesions.