薄层液基细胞学检查对宫颈病变的诊断价值

Value of TCT in diagnosis of cervical precancerous lesions

目的评价薄层液基细胞学检查（TCT）对宫颈病变的诊断价值。方法对2010年4月至2012年3月于建德市第一人民医院妇科门诊检查的3590例患者行TCT检查，报告结果使用TBS分类系统，共检出360例细胞学结果异常者，其中221例行阴道镜下活检。结果221例接受阴道镜活检者中，共检出宫颈上皮内瘤变（CIN）Ⅰ56例，CINⅡ／Ⅲ55例，鳞状细胞癌（SCC）6例，细胞学与阴道镜活检结果的符合率分别为鳞状上皮内低度病变（LSIL）51．56％（33／64），鳞状上皮内高度病变（HSIL）73．91％（34／46），SCC83．33％（5／6）；细胞学提示为不典型鳞状细胞（ASCUS）的105例患者中，经活检诊断为有异常者为19．05％（20例，分别为CINⅠ12例及CINⅡ／Ⅲ8例）；TCT与病检结果诊断一致性的Kappa值为0．646，P〈0．01；TCT细胞学检查的灵敏度（Se）、特异度（S p）分别为82．90％和81．73％。结论薄层液基细胞学（TCT）在宫颈癌前病变及宫颈癌筛查中具有较高的临床应用价值。

Objective To assess the value of thin-prep cytology test （TCT） in diagnosis of cervical precancerous lesions. Methods From April 2010 to March 2012, 3 590 patients performed TCT in Gynecology Department of First People＇ s Hospital of Jiande, and the Bethesda system （TBS） was used to report outcomes. There were 360 cases with abnormal outcomes, and 221 of them accepted biopsy under colposcopy. Results In 221 cases accepting biopsy, there were 56 cases of cervical intraepithelial neoplasia （CIN） Ⅰ, 55 cases of CIN Ⅱ/ Ⅲ and 6 cases of squamous cell carcinoma （SCC）. The coincidence rate of cytology and colposcopy biopsy results was 51.56% （33/64） for low grade squamous intraepithelial lesion （LSIL） , 73.91% （34/46） for high grade squamous intraepithelial lesion （HSIL） , and 83.33% （5/6） for SCC respectively. Among 105 cases of ASCUS showed by cytology, 19.05% were diagnosed with abnormity by biopsy （20 cases, 12 of CIN Ⅰ and 8 of CIN Ⅱ/ Ⅲ ）. The Kappa value of TCT and biopsy was 0. 646 （P 〈 0.01 ）. The sensitivity and specificity of TCT was 82.90% and 81.73%, respectively. Conclusion TCT has high clinical value in diagnosis of cervical precancerous lesions and cervical carcinoma screening.