液基细胞学筛查宫颈病变的价值

Analysis of liquid-based cytology for cervical lesions screening

目的:探讨液基细胞学检测(TCT)在妇女宫颈病变中的诊断价值。方法:选择无锡第二人民医院2007年1月～2009年10月的5010例患者进行TCT检测,采用TBS分类标准诊断,对351例细胞学检查阳性者及197例细胞学检查阴性、临床可疑病史或体征者行阴道镜检查及宫颈多点活检,将细胞学检查结果与组织病理学结果作对比分析。结果:5010例满意标本中细胞学阳性病例392例,阳性检出率7.82%。其中非典型鳞状细胞(ASCUS)279例(5.57%),低度鳞状上皮内病变(LSIL)72例(1.44%),高度鳞状上皮内病变(HSIL)35例(0.70%),鳞癌(SCC)6例(0.12%)。548例病例阴道镜检查+活检,结果显示细胞学LSIL以上病变阳性率30.29%(166/548)与组织学CINⅠ以上病变阳性率35.40%(194/548)两者比较差异无统计学意义(P>0.05);细胞学诊断的各级假阴性率分别为LSIL30.51%(36/118)、HSIL26.76%(19/71)、SCC20.00%(1/5),各级假阳性率分别为LSIL22.40%(28/125)、HSIL0.00%(0/35)、SCC0.00%(0/6)。结论:TCT能准确反映宫颈病变情况,在妇女宫颈病变筛查中有较高的临床应用价值,可推荐为临床宫颈癌筛查方法;阴道镜检查及宫颈多点活检可弥补液基细胞学检查假阴性的疏漏,最终的诊断需要组织病理学来确诊。

Objective：To explore the diagnostic value of liquid-based cytology test （TCT） for gynaecological cervical lesions..Methods：5 010 patients screened for cervical lesions in this hospital from January 2007 to October 2009, were selected to adopt TCT detection and TBS detection of diagnostic classification. The cytology and biopsy results of 351 cases of cytology-positive and 197 patients of cytology-negative with suspicious clinical diagnosis which took colposcopy and multi-point biopsy were compared..Results：The cytology-positive rate was 7.82% in 5 010 patients.. And ASCUS was 5.57%, LSIL 1.44%, HSIL 0.70%, SCC 0.12%.. In 548 patients with colposcopy examination and multi-point biopsy, the cytological positive rate of LSIL or severer lesion was 30.29%（166/548）, and histological positive rate of CINⅠ or severer lesion was 35.40%, there was no significant difference（P〉0.05）. The cytological rate of false negative was 30.51% for LSIL, 26.76% for HSIL, 25.00% for SCC, the false positive rate was 22.40% for LISL, 0.00% for HSIL, 0.00% for SCC.Conclusion：Liquid-based cytology test can exactly reflect cervical lesions. It can be used to check cervical cancer with its high clinical application value in screening gynecological cervical lesions. Colposcopy and multi-point biopsy can make up the cytological false negative detection. The final diagnosis of cervical lesions should be determined by histological pathology.