61610例宫颈液基薄层细胞学检查的统计与分析

Liquid-Based Cervical Cytology for Cervical Cancer Screening: A Retrospective Analysis of 61610 Cases

目的探讨准确评价薄层液基细胞学检查（LCT）在宫颈癌筛查中的应用价值。方法回顾性分析2004年3月至2011年3月本院收集的61610例标本的LCT结果，与阴道镜下多点组织活检结果进行对照研究，并与同期收集的128554例传统巴氏涂片（Papsmears）检查结果进行对照分析。结果①61610例LCT的复检结果为，未明确意义不典型鳞状细胞（ASCUS）及以上患者为1772例（2．88％，1772／61610），对其中1017例进行多点组织活检发现，38例（0．06％，38／61610）为鳞状上皮细胞癌（SCC）及腺癌（GLCA）；251例（0．41％，251／61610）为高级别鳞状上皮内病变（HSIL）[子宫上皮内瘤变（CIN）Ⅱ～Ⅲ级分别为169例和82例]；409例（0．66％，409／61610）为低级别鳞状上皮内病变（LSIL）（湿疣为216例，CINI级为193例），腺上皮不典型增生（AGC）为5例，宫颈原位癌（AIS）为2例；慢性炎症为312例。同期进行巴氏涂片检查的128554例标本中，共检出巴氏Ⅲ级及以上为272例（0．211％），其中253例进行组织活检发现，65例为SCC和GLCA，97例为HSII，（CINⅡ～Ⅲ级分别为40例和57例），82例为LSII。（CINI级为45例、湿疣为37），慢性炎症为9例。两种方法在筛查宫颈癌方面比较，差异无统计学意义（P〉0．05），但在筛查宫颈鳞状上皮病变（SIL）方面，LCT明显优于巴氏涂片，两者比较，差异有统计学意义（P〈0．05）。②LCT诊断与组织学诊断的符合率分别为HSIL（82．77％，173／209）〉SCC（73．53％，25／34）〉LSIL（63．46264／416），LCT的假阳性主要来源于对LSIL的判定。结论LCT筛查CIN和宫颈癌较灵敏、可靠，明显优于传统巴氏涂片，特别是筛查高级别CIN，具有重大意义，但在筛查宫颈癌时，若存在因有效细胞数目过少、细胞重叠、炎症背景杂乱等因素，则可能造成漏诊或严重低诊，临床应引起重视。

Objective To evaluate the value of liquid-based cytological test （LCT） as a screening method to detect cervical carcinoma. Methods The clinical data of 61 610 cases were collected from March 2004 to March 2011. The LCT results and colposcopic biopsy of 61 610 cases and 128 554 conventional Papnicoulau smears （CP） were compared and retrospectively analyzed. Follow-up diagnoses of colposcopic biopsy were available for those previously detected cytological abnormalities. Results Among 61 610 LCT results, 1772 （2.88%） cases were cytological interpreted as atypical squamous cell of undetermined significance （ASCUS） or above, and among them, 1017 cases who received colposeopic biopsy showed 38 （0. 06%, 38/61 610） were squamous cell carcinoma （SCC） or cervical adenocarcinoma （GLCA）, 251 （0.41%, 284/61 610） were high grade squamous intraepithelial lesions （HSIL） [cervical intraepithelial neoplasia （CIN） Ⅱ, Ⅲ were 169 cases and 82 cases, respectively], 409 （0.66% ; 399/61 610） were low grade squamous intraepithelial lesions （LSIL） （216 were condyloma and 193 were CIN I）, atypical glandular cell （AGC） were 5 cases, adenocareinomain situ （AIS） were 2 eases, and chronic inflammation were 312 cases. In the results of 128 554 specimen by CP, 272 cases （0.21%） were cytological interpreted as Pap l]] or above. Among these 272 cases, 253 who received biopsy showed that 65 cases were cytological interpreted as SCC or GLCA, 97 were HSIL including 57 for CIN Ⅱ and 40 for CIN Ⅲ, 82 were LSIL including 45 for CIN I and 37 for condyloma, 9 were chronic inflammation. There was no significant difference between CP and LCT in detecting cervical carcinoma. （2） The consistent rate of LCT and histological diagnosis was the follow： HSIL（82.77%, 173/209）〉SCC（73.53% ,25/34） 〉LSIL（63.46%, 264/416）. Conclusions Compared with CP, LCT has more sensitivity and reliability in screening for cervical carcinoma and SIL, especially in detecting HSII.. But we must pay more attention to the misdiagnosis or under-diagnosis of cervical carcinoma because of scant cellular, cell overlying, inflammation, etc. in the preparations.