宫颈液基细胞学与组织病理学诊断结果不一致性研究

Study of diagnosis results discrepancy between cervical liquid-based cytology and histopathology

目的探讨宫颈液基细胞学与组织病理学诊断结果的一致性，寻找和分析引起不一致的原因。方法将我院2011年1月至2011年12月间行液基细胞学检查与组织病理学结果进行比对，以组织病理结果为金标准，分析两者的符合率及不一致原因。结果19832例液基细胞学检查结果中有898例进行病理活检。在细胞学明确诊断病例中，正常范围或良性反应性改变（negativeforintraepitheliallesionormalignancy，NILM）、低度鳞状上皮内病变（10w—gradesquamousintraepitheliallesion，LSIL）、高度鳞状上皮内病变（high—gradesquamousintraepitheliallesion，HSIL）和宫颈癌（squamouscellscancer，SCC）与组织病理学诊断结果的符合牢分别为96．65％（462／478）、64．44％（87／135）、68．67％（57／83）和100．00％（10／10），总符合率为87．25％（616／706）。住细胞学未明确诊断病例中，非典型鳞状上皮细胞意义不明确144例，活检阳性率22．92％；不能除外高级别鳞状上皮内病变54例，活检阳性率71．05％。NILM、LSIL、HSIL和SCC不一致率分别为3．35％（16／478）、35．56％（48／135）、31．33％（26／83）和0．00％（0／10）。不一致原因包括标本错误（42．22％）、判读错误（18．89％）、标本与判读均错误（38．89％）。结论随着病变程度的增高，细胞学诊断分级也随着上升，标本质量是影响细胞学发挥最佳诊断的主要原因。

Objective To evaluate the coincidence rate between cervical liquid-based cytological and histopathologic diagnosis and to analyze the noncoincidence reasons. Methods A review of all patients be- tween January and December 2011 diagnosed with a discrepancy that was compared cytological diagnosis with histopathologic diagnosis was performed. Histopathologic diagnosis was used as the gold standard, and the co- incidence rate and noncoincidence reasons were analyzed. Results 898 cases were carried out by biopsy in 19 832 of cervical liquid-based cytology. Compaired with the histopathological diagnosis, the coincidence rate of negative for intraepithelial lesion or malignancy（NILM）, low-grade squamous intraepithelial lesion （LSIL）, high-grade squamous intraepithelial lesion （HSIL） and squamous cells cancer（SCC） were respectively 96.65% （462/478）, 64.44% （87/135）, 68.67% （57/83）and 100.00% （10/10）, and the total coincidence rate was 87.25% （616/706） in the patients diagnosd definitely by cytological method. In the patients diagnosed undefi- nitely by cytological method, there were 144 cases in atypical squamous cells of undetermined significance and the positive rate was 22.92% by biopsy. There were 54 cases in atypical squamous cells cannot exclude HSIL and the positive rate was 71.05% by biopsy. The inconsistent rate of NILM, LSIL, HSIL and SCC was 3.35% （ 16/478 ）, 35.56% （48/135 ）, 31.33% （26/83） and 0.00% （0/10）, respectively. The noncoincidence reasons were including specimen errors （42.22%）, interpretation errors （ 18.89% ） and the both （38.89%）. Conclusion As the lesions increasing, the degree of cytology classification is rising. The specimen errors are responsible for the majority of cytology/histology discrepancies.