宫颈液基薄层细胞学和组织病理学对照研究

Comparison of cervical ThinPrep cytology test and histopathology detection

目的探讨液基薄层细胞学(thinPrep cytologytest,TCT)筛查宫颈上皮内瘤变的价值。方法回顾性分析11 922例妇女(年龄范围为17～84岁)宫颈TCT检查结果 ,与宫颈活检和术后组织学比较分析。结果检出未明确诊断意义的非典型鳞状细胞(atypical squamous cells of undetermined significance,ASCUS)及以上病变共312例(2.62%),其中ASCUS173例,非典型鳞状细胞-不除外上皮内高度病变(atypical squamous cells-cannot excludeHSIL,ASC-H)12例,低度鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)76例,高度鳞状上皮内病变(high-grade squamous intraepitheliallesion,HSIL)48例,鳞状细胞癌(squamous cell carcinoma,SCC)3例。157例进行宫颈活检组织病理学检查。其中59例ASCUS经组织病理学分别诊断为阴性17例(28.8%),HPV感染15例(25.4%),CINⅠ13例(22.0%),CINⅡ11例(18.6%),CINⅢ3例(5%)。LSIL、HSIL及SCC病例中与组织病理学一致率分别为35.2%(19/54)、67.7%(21/31)及100%(3/3)。HSIL组的组织学符合率高于LSIL组(x^2=8.38,P<0.01)。宫颈活检与术后病理结果一致率为75%(27/36)。结论 HSIL诊断与组织学有较高的符合率。ASCUS的诊断是TCT检查中的难点,其准确性对提高TCT诊断报告的水平具有重要意义。

Objective To evaluate ThinPrep cytology test （TCT） in diagnosis of cervical intraepithelial neoplasia. Methods The results of thinprep cytology test from 11 922 patients （aged from 17 to 84） were analyzed retrospectively. And the data from cervical biopsies and surgical excision histology were compared. Results Three hundred and twenty-one positive cases with abnormal epithelial cells were diagnosed by TCT（2.62% ）. Among the 312 cases, 173 cases were diagnosed with atypical squamous cells of undetermined significance （ASCUS）, 12 cases with atypical squamous cells, cannot exclude HSIL（ASC-H）, 76 cases with low-grade squamous intraepithelial lesion （LSIL）, 48 cases with high-grade squamous intraepithelial lesion （HSIL） and 3 cases with squamous cell carcinoma（SCC）. However, only 157 of 321 cases were carried out cervical biopsy. The biopsy results from 59 cases with ASCUS showed that 17 cases （28.8%）were negative, 15 cases （25.4%） with human papilloma virus （HPV） infection, 13 cases （22.0%）with cervical intraepithelial neoplasia Ⅰ （ CIN Ⅰ ）, 11 cases （18.6%） with CIN Ⅱ and 3 cases （5%） with CIN Ⅲ. In comparison with TCT and cervical histology results, the rate of consistent results were 35.2% （19/54） for LSIL, 67.7% （21/31）for HSL, 100% （3/3） for SCC respectively. But HSIL with histology has higher consistency than that of LSIL with histology （X2--8.38,P〈0.01）. The consistent diagnostic results from cervical biopsy and surgical excision was 75% （27/36）. Conclusion Diagnosis of HSIL by TCT has a good consistent with cervical histology. But the diagnosis of ASCUS with TCT,is more difficult. Improving the accuracy diagnosis of ASCUS by TCT is an important way for clinical applications.