宫颈不典型鳞状细胞ASCUS的临床处理探讨

Strategy for the Clinical Management of Atypical Squamous Cells of Undetermined Significance

目的：探讨宫颈细胞学检查ASCUS（未明确诊断意义的不典型鳞状细胞）的临床意义和处理方法.方法：2007年8月至2009年6月,对上海市闵行区中医医院妇科就诊的119例细胞学检查报告为ASCUS患者行阴道镜评估与镜下活检并对比其检查结果,同时进行了高危人类乳头瘤病毒（High-risk human papillomarirus,HPV）检测.结果：ASCUS患者中包含43例（36.13%）宫颈上皮内瘤变（CIN）及原位癌,其中CIN Ⅰ 29例（24.37%）、CIN Ⅱ 9例（7.56%）、CIN Ⅲ 4例（3.36%）及原位癌1例（0.84%）.高危HPV阳性51例（42.86%）,其中33例为上皮内瘤变（64.71%）,高危HPV阴性68例,其中10例为上皮内瘤变,高危HPV阳性组CIN检出率明显高于阴性组,两者比较有统计学意义（x2=32.9,P〈0.05）.HPV检测和阴道镜检查诊断上皮内瘤变的灵敏度,分别为76.74%和81.40%,两者比较无统计学意义（P〉0.05）.结论：宫颈细胞学诊断为ASCUS的病例中上皮内瘤变率高,应加强对AS-CUS患者的重视.高危HPV检测和阴道镜检查是对ASCUS进一步处理的有效方法,尤其对高危型HPV阳性的病例,应在阴道镜下行活组织检查,正确运用这两种方法,可提高宫颈病变筛查的阳性率.

Objective： To assess the clinical significance of atypical squamous cells of undetermined significance （AS- CUS） and the value of Human Papillomavirus （HPV） testing. Methods： From August 2007 to June 2009, a total of 119 women were diagnosed with ASCUS by cytological testing at Zhongshan Hospital. Biopsies were taken during colposcopy, and all cases were tested together with high-risk HPV-DNA testing. Results： Among the 119 patients investigated, 43 patients were diagnosed with cervical intraepithelial neoplasia （CIN）. The detection rate of CIN in the HPV positive group was a lot higher than that of the negative group. Of the 51 cases positive for HPV, 33 cases also had CIN （x2=32.9, P〈 0.05）. No significant difference was found in the sensitivity between the HPV test and colposcopy （P〉0.05）. Conclusion： Colposcopy and high risk HPV test are both effective methods to detect ASCUS. When used in combination, they can also improve detection rate and accuracy of cervical intraepithelial neoplasia （CIN）. Attention must be paid to the increased occurrence of CIN in women with ASCUS and knowledge of CIN rates should be used to strengthen management of the disease.