宫颈新柏氏液基细胞学检查假阴性结果分析

The result analysis about the false-negative report of cervical ThinPrep cytologic test

目的分析宫颈新柏氏液基薄层细胞学检查(thinprepliquidbasedcytologictest,TCT)出现假阴性的原因。方法记录同时行TCT检查、高危型人乳头状瘤病毒(highrisk-humanpapillomavirus,HR-HPV)DNA检测及电子阴道镜定位活检病理检查的患者的检查结果 ,回顾性分析其中18例病理结果阳性而TCT结果阴性病例的TCT涂片,分别记录其细胞量、有无颈管细胞或化生细胞、是否为出血涂片、病灶与宫颈管距离及组织病理结果。结果原细胞学诊断阴性复查为阳性、细胞量<40%、无颈管细胞或化生细胞、出血涂片、重度炎症、病灶与宫颈管距离>1cm者,在假阴性病例中分别占5.56%、11.11%、44.44%、22.22%、11.11%、5.56%。TCT假阴性率高于TCT+HR-HPV假阴性率,差异有统计学意义(P<0.05)。结论规范取材方法 ,加强医师自身的阅片能力及应用更完善的技术(如TCT制片后加用计算机辅助细胞检测系统或TCT联合HR-HPVDNA检测)可以降低TCT假阴性率;临床医师对症状体征可疑但细胞学阴性的病例采取阴道镜下多点活检可减少假阴性的发生。

Objective To review the false - negative cases in cervical thinprep liquid based cytologic test （TCT） and analyze the causes of the false negative reports. Methods The results of patients who had simultaneously taken the cervical TCT and high - risk human papilloma virus test （ HR - HPV ） and localization biopsy by vaginoscopy were all recorded. The results of 18 cases with negative in TCT but positive in biopsy diagnosis were retrospectively analyzed. Cells amount, endocervical column cells, metaplastic cells, smear with blood ceils, serious inflammation and distance from the lesion to endocervical tube were recorded in all the cases. Results The positive cases after review, cellular rate less than 40%, absence of endocervical transformation zone, stain with blood cell, serious inflammation and distance from the lesion to endocervical tube were 5.56%, 11.11%, 44.44%, 24. 67% , 11.11%, 5.56% respectively among the false - negative cases. The false negative rate of TCT was higher than that of TCT plus HR - HPV that the difference was statistically significant between them （ P 〈 0.05 ）. Conehtsion The standard specimens, the improvement of physician＇s film - reading skill in diagnosis and the application of the perfect technologies, such as adding computer - assisted cytologic test system after TCT or TCT plus HR - HPV DNA test can reduce the false negative rate. It＇ s important that gynecologists do multiple biopsies under vaginoscope to the patients who are suspicious of cancer but negative cytology.