液基细胞学联合阴道镜检查在诊断宫颈病变中的临床价值

The Clinical Value of Cervical Lesions Detected by Liquid-based Cytology and Vaginoscopy

目的:探讨液基细胞学联合阴道镜检查在诊断宫颈病变中的临床价值。方法:对530例妇科患者进行液基细胞学检查,细胞学阳性者再行阴道镜下活检可疑病灶病理检查,以病理组织学诊断为金标准,用阳性符合率评价液基细胞学检查和阴道镜检查在诊断宫颈病变的临床价值。结果:液基细胞学检出阳性标本145例,总阳性检出率为27.35%。其中非典型鳞状上皮细胞(ASCUS)60例(占41.37%),鳞状上皮内低度病变(LSIL)45例(占31.03%),鳞状上皮内高度病变(HSIL)26例(占17.93%),鳞状细胞癌(SCC)6例(占4.14%),人乳头瘤病毒感染(HPV)8例;与阴道镜下活组织病理检查阳性符合率分别为LSIL80.36%(45/56),HSIL(CINⅡ12/14、CINⅢ14/14)92.86%,SCC100%(6/6)。阳性检出率集中在20-50岁之间,而宫颈低度病变主要发生在20-40岁之间,CINⅠ以30-40岁年龄段最为集中,占57.14%;宫颈高度病变主要集中在40-50岁之间,占64.29%。结论:液基细胞学检查联合阴道镜下病理检查宫颈病变敏感性高,准确度高,尤其对HSIL诊断率高,有利于提高宫颈癌及癌前病变的早期诊断。

Objective： To investigate the clinical value of cervical lesions detected by liquid-based cytology and vaginoscopy.Method：530 cases with positive liquid-based cytology received biopsy for the suspected lesion through vagionoscopy.Histologic diagnosis for gold standard,the clinical value used positive accuracy evaluation liquid-based cytology and vaginoscopy in diagnosis of cervical disease.Result：145 cases were detected with positive liquid-based cytology,the total positive rate was 27.35%.60 cases with ASCUS（41.37%）,45 cases with LSIL（31.03%）,26 cases with HSIL（17.93%）,6 cases with SCC（4.14%） and 8 cases with HPV（5.52%） respectively.Combined with bioptic pathology,the diagnostic accuracy rate was 80.36%（45/56） in LSIL,92.86% in HSIL（CINⅡ12/14,CINⅢ14/14） and 100%（6/6） in SCC respectively.The positive rate concentrated in 20 to 50 years old,and LSIL occured predominantly in 20 to 40 years old,CINⅠfocus in 30 to 40 years old（57.14%）;Cervical highly lesions were mainly concentrated in 40 to 50 years old（64.29%）.Conclusion：Liquid-based cytology and vaginoscopy have high sensitivity,strong accuracy rate and high diagnostic rate,especially to HSIL.These methods improve the early diagnosis for cervical carcinoma and pathological changes before cervical carcinoma.