宫颈细胞学ASCUS诊断的临床意义及处理

Clinical significance and treatment of ASCUS diagnosed by cervical pathological examination

目的:探讨意义未明的不典型鳞状细胞(Atypical squamous cells of undetermined significance,ASCUS)的临床意义及处理方法。方法:回顾性分析490例宫颈液基细胞学检查(TCT)诊断为ASCUS患者的临床资料,其中267例同时进行了HPV分型检测。结果:490例宫颈细胞学ASCUS诊断中,组织病理学结果为炎症201例(41.02%),宫颈上皮内瘤样病变(CIN)Ⅰ级144例(29.39%),CINⅡ/Ⅲ级114例(23.27%),宫颈癌31例(6.33%);高危型HPV(HR-HPV)阳性组CINⅡ级以上病变检出率为42.72%(88/206),明显高于HR-HPV阴性组22.95%(14/61),差异有统计学意义(χ2=7.79,P=0.005)。结论:细胞学报告为ASCUS时,组织病理学检查结果从炎症到宫颈癌均有分布,对其临床处理应引起重视。HR-HPV检测对ASC-US的临床处理具有科学分流管理的意义。

Objective： To explore the clinical significance and treatment of atypical squamous cells of undetermined significance （ASCUS） diagnosed by cervical pathological examination. Methods： Clinical data of 490 cases diagnosed as ASCUS by liquid -based cervical cytology were analyzed retrospectively, and 267 cases underwent HPV genotyping test among 490 cases. Results： Among 490 cases diagnosed as ASCUS by liquid -based cervical cytology, 201 cases （41.02%） were diagnosed as inflammation, 144 cases （29. 39% ） were diagnosed as CIN Ⅰ , 114 cases （23.27%） were diagnosed as CIN Ⅱ/Ⅲ, 31 cases （6. 33% ） were diagnosed as cervical cancer by histopathological examination; in high -risk HPV positive group, the detection rate of CIN Ⅱ or above lesions was 42. 72% （88/206）, which was significantly higher than that in high - risk HPV negative group [22. 95% （ 14/61 ） ], there was significant difference （X^2 =7.79, P = 0. 005） . Conclusion： The histopathological results in patients with ASCUS disperse from cervicitis to cervical cancer, the treatment of patients with ASCUS should be paid more attention to. High - risk HPV detection plays a scientific triage role in clinical management of ASCUS.