液基薄层细胞学在筛查宫颈病变中的临床意义

Clinical significance of Thinprep cytology test in screening of cervical lesions

目的:探讨液基薄层细胞学在筛查子宫颈病变中的临床意义。方法:对2012年1月～12月第三军医大学大坪医院18 904例门诊患者进行TCT筛查,发现细胞学异常(TBS系统诊断≥ASC-US)的患者688例,其中416例进行了阴道镜检查并取活检,以病理学为标准,评价TCT筛查子宫颈病变的临床意义。结果:细胞学异常的416例患者中,ASC 195例,LSIL65例,HSIL 138例,宫颈癌52例,病理学诊断为炎症128例,CINⅠ106例,CINⅡ78例,CINⅢ52例,浸润癌52例(其中腺癌1例),TCT与病理组织诊断符合率:ASC为48.21%,LSIL为81.54%,HSIL为89.13%,宫颈癌为100.00%,对宫颈高度病变(≥CINⅡ),TCT(≥LSIL)的敏感性为90.66%,特异性为76.07%。结论:TCT能提高涂片异常细胞的检出率,与组织病理学检查结果符合率高,有较高的敏感性,可减少漏诊,是适合宫颈病变筛查的有效方法。

Objective： To explore the clinical significance of Thinprep cytology test （TCT） in screening of cervical lesions. Methods： TCT screening was conducted among 18 904 patients from outpatient department of Daping Hospital Affiliated to the Third Military Medical University from January to Deeember in 2012, and 688 patients were found with cytological abnormalities （ diagnosis of TBS system ≥ ASC - US） , then 416 patients underwent colposeopy and biopsy ; the clinical significance of TCT in screening of cervical lesions was evaluated with pathological examination as gold standard. Results： A total of 416 patients were found with cytological abnormalities, including 195 patients with ASC, 65 patients with LSIL, 138 patients with HSIL, and 52 patients with cervical cancer; 128 patients with cervicitis, 106 patients with cervical intraepithelial neoplasia （CIN） I , 78 patients with CIN II , 52 patients with CINⅢ, and 52 patients with cervical invasive carcinoma （including one patient with cervical adenocarcinoma） were found by pathological examination; the coincidence rates of diagnosis between pathological examination and TCT were 48.21% （ASC） , 81.54% （LSIL） , 89. 13% （HSIL） , and 100. 00% （cervical cancer） , respectively; the sensitivity and specificity of TCT for cervical lesions （ Ⅱ CIN Ⅱ ） were 90. 66% and 76. 07%, respectively. Conclusion ： TCT can improve, the detection rate of cervical lesions and it has a high concordance with the histopathological results with high sensitivity, TCT is an effective method for screening cervical lesions and missed diagnosis can be reduced.