宫颈液基细胞学检查对宫颈病变的筛查价值-附38088例分析

Liquid-based cytologic screening on cervical lesion:a study of 38088 cases

目的:探讨液基细胞学检查(Thinprep cytology test,TCT)对宫颈病变的筛查价值。方法:回顾性分析2003年7月至2007年7月在重庆医科大学附属第一医院妇科38 088例TCT结果,阳性者定期复查或行阴道镜检查,必要时在阴道镜引导下定位活检。对有完整资料的1 556例病理结果按年龄进行分组分析,并对TCT与活检组织病理结果的相关性进行统计学分析。结果:38 088例TCT检测中,异常者2 462例,有明确阴道镜活检病理结果者1 556例,病理证实CINⅠ、CINⅡ、CINⅢ、宫颈癌及HPV感染病例分别为279、314、365、75例和94例。TCT与病理结果符合率为60.35%,TCT筛查宫颈病变的灵敏度为84%,特异度为53%,阳性预测值为83%,阴性预测值为56%。30～39岁为宫颈上皮内瘤变和人乳头瘤病毒的高发年龄段、宫颈癌的高发年龄段为30～49岁。TCT阳性者发生CINⅠ、CINⅡ和CINⅢ的相对危险度分别为:非典型鳞状细胞为11.11、13.21、8.19,鳞状上皮内低度病变为22.60、20.72、13.66,鳞状上皮内高度病变为10.33、25.45、54.65。结论:TCT筛查宫颈病变的阳性率、阳性预测值与活检病理结果符合率均较高,对病理结果有一定的预测价值,TCT阳性者宫颈病变的危险较一般人群明显升高。

Objective：To investigate the accuracy of Thin-Prep-liquid-based cytology test for cervical lesion with histopathological diagnosis as the criteria.Methods：TCT results of 38088 cases admitted to the First Affiliated Hospital of Chongqing Medical University from July 2003 to July 2007 were retrospectively studied.The patients with positive result underwent regular check or colposcopy,and,if necessary,cervical biopsy under guidance of colposcope.A total of 1 556 samples with complete data were divided into groups and analyzed.The relativity of TCT results to biopsy pathological diagnosis was statistically analyzed.Results：The results of TCT examination for 38 088 cases indicated that 2 462 cases were abnormal and 1 556 cases had definite colposcope directed biopsy results,and the pathological results confirmed that the abnormal cases of CINⅠ,CINⅡ,CINⅢ,ICC and HPV infection were 279,314,365,75 and 94 respectively.The agreement of TCT and pathological results was 60.35%.The sensitivity and specificity of TCT were 0.84 and 0.53 respectively.The positive and negative predictive values were 0.83 and 0.56 respectively.CIN and HPV had high incidences at age 30 to 39,while ICC peaked at 30 to 49.In TCT positive group,the relative risks of ASC progressing to CINⅠ,CINⅡ and CINⅢ were 11.11,13.21 and 8.19 respectively of LSIL progressing to CINⅠ,CINⅡ and CINⅢ were 22.60,20.72 and 13.66 respectively and of HSIL progressing to CINⅠ,CINⅡ and CIN3 were 10.33,25.45 and 54.65 respectively.Conclusion：TCT has high agreement with biopsy in positive rate and positive predictive rate for cervical lesion screening,which suggests that TCT has certain predicative value for pathological results.The risk of cervical lesion in TCT positive group is significantly higher than that in negative group.