液基薄层细胞检查在宫颈癌及癌前病变筛查中的应用

Application of liquid based cytology in screening cervical cancer and precancerous lesions

目的探讨应用新柏氏液基细胞检查（thinprep cytologytest，TCT）筛查宫颈癌及癌前病变的准确性。方法回顾性分析2008年1～6月在本院接受宫颈TCT检查的患者3859例，细胞学诊断采用TBS（the bethesda system）标准，细胞学结果为非典型鳞状上皮细胞不除外高度病变（atypical squamous cellcannot exclude HSIL，ASC—H）者、所有低度鳞状上皮内病变（low—grade intraepithelial lesion，LSIL）及其以上鳞状上皮病变者均在阴道镜指导下进行活检，组织送病理学检查，将TCT结果与病理诊断对照分析。结果3859例TCT检查者中，ASC-H40例（1．04％），LSIL48例（1．24％），高度鳞状上皮内病变（high—grade intraepithelial lesion，HSIL）31例（CINⅡ25例，CINⅢ6例，分别占0．65％和0．16％），鳞状细胞癌（squamous cell carcinoma，SCC）2例（0．05％），与病理活检符合率分别为82．5％、70．8％、90．3％和100％。经统计学处理，TCT对HSIL及以上病变的诊断与阴道镜下病理活检符合率显著高于对LSIL的诊断符合率，二者差异有统计学意义（P〈0．05）。细胞学阳性患者年龄分布以31～40岁组为主，占43．2％。结论TCT技术结合TBS分级标准进行宫颈癌及癌前病变的筛查可靠，特别对HSIL以上病变准确性高。对生育年龄妇女，特别是31～40岁组妇女进行宫颈癌及癌前病变的筛查十分必要。

Objective To investigate the application of Thinprep cytology test （TCT） screening for cervical cancer and precancerous lesions and its accuracy. Methods To conduct the retrospective analysis on 3 859 cases of TCT from January to June in 2008 in our hospital. All the cases of squamous epithelial lesions diagnosed cytologically using TBS standard including squamous cell-can-not exclude HSIL （ASC H）,low-grade intraepithelial lesion （LSIL） and above lesions accepted routine colposcopy and biopsy. The TCT results were compared with the biopsy results. Results There were 40（1. 04%） cases with ASC-H,48（1.24%） cases of LSIL,31 cases （CIN II 25 cases and CIN III 6 cases,accounting for 0.65% and 0.16% respectively） of high-grade squamous intraepithelial lesion （HSII.） and 2（0.05%） cases of squamous cell carcinoma （SCC） in 3 895 cases of TCT,which coincidence rate with biopsy was 82. 5%, 70. 8%, 90. 3% and 100% respectively. In the statistical analysis, the coincidence rate of TCT diagnosis of HSIL and above lesions to pathological biopsy by colposcopy was higher than that of LSIL with statistical difference （P〈0.05）. In age distribution,the cytology positive patients were mainly 31-40 year old group,accounting for 43.2%. Conclusion TCT technology combined with TBS classification standard is reliabe for screening cervical cancer and precancerous lesions, with high accuracy especially to HSIL and above lesions. It is necessary to screen cervical cancer and precancerous lesions for child bearing women,particularly women of 31--40 years old group.