6498例宫颈液基细胞学检查结果分析

Clinical analysis on results of cervical cytology screening:report of 6498 cases

目的探讨宫颈液基细胞学检查(liquid-based cytological test,LCT)与宫颈活检的符合率及LCT结合宫颈活检在宫颈上皮性病变早期诊断中的临床价值。方法回顾性分析6 498例妇科患者宫颈LCT结果,阳性病例共377例,其中148例行宫颈活检。比较细胞学与组织学结果并研究发病率与年龄的关系。结果 6 498例LCT检查中细胞学检查阳性率为5.80%,其中ASC-US 215例(在阳性病例中占57.03%),ASC-H 36例(9.55%),LSIL 82例(21.75%),HSIL为39例(10.34%),AGC-NOS为4例(1.06%),SCC 1例(0.27%);宫颈活检148例,其中炎性反应39例(26.35%),挖空细胞15例(10.14%),CINⅠ级32例(21.62%),CINⅡ级35例(23.65%),CINⅢ级17例(11.49%),鳞癌9例(6.08%),腺癌1例(0.68%),以组织学结果验证细胞学结果,符合率分别为LSIL(61.7%),HSIL(71.43%),SCC(100%);宫颈病变多见于30～50岁年龄段。结论宫颈LCT是筛查宫颈上皮性病变方便、准确的手段,结合阴道镜及宫颈活检进一步检查可使宫颈上皮内瘤变和宫颈癌得到早期诊断。

Objective To investigate the diagnose accordance rate of liquid-based cytology test （LCT） and tissue biopsy for cervix, and to investigate the clinical application value of LCT combined with tissue biopsy in early screening for cervical epithelial lesions. Methods The results of 6 498 cases undergoing cervical LCT inspection during January to December 2011 were retrospectively analyzed. Patients with atypical squamous cells of undetermined significance （ASC-US） or severe than ASC-US were defined as abnormal cytology accord- ing to Bethesda system for cytology classifications. Among 377 cases of abnormal cytology, 148 cases received biopsy inspection. The cytology and histology results were compared, and the relationship of lesion and ages were analyzed. Results In 6 498 cases receiving cervical LCT, the abnormal cytology ratio was 5.80%. Among them, ASC-US were 215 cases （57.03%）, atypical squamous cell cannot exclude high grade squamous intraepithelial lesion （ASC-H） were 36 cases （9.55%）, low grade squamous intraepithelial lesion （LSIL） were 82 cases （21.75%） , high grade squamous intraepithelial lesion （HSIL） were 39 cases （ 10.34% ） , atypical glandular cells of undetermined significance not otherwise specified （AGC-NOS） were 4 cases （1.06%）, and squamous cell carcinoma （SCC） were 1 cases （0.27%）. Among the 148 cases of biopsy, eases of inflammation reaction were 39 cases （26.35%）, koilocytotie cells 16 cases （ 10.81% ）, cervical intraepithelial neoplasia （CIN Ⅰ ） 32 cases （21.62%）, C IN Ⅱ 35 cases （23.65%）, CIN Ⅲ17 cases （11.49%）, squamous carcinoma 8 cases （5.41%） , and adenocareinoma 1 cases （0.68%） , which revealing that the cytology results had a high conformity rate with biopsy results. And the onset age of cervical lesions ranged from 30 to 50. Conclusion LCT is an important approach of screening for cervical epithelial lesions with its high accuracy. Combination of LCT and tissue biopsy can greatly improve early diagnosis of CIN and carcinoma in cervix.