液基细胞学筛查宫颈癌的研究

Comparative study on liquid-based cytology for cervical carcinoma screening in a high-risk area of China

目的 评价ThinPrep液基细胞学在宫颈癌高发区筛查的准确性。方法 1997例受检者同时做宫颈脱落细胞液基标本采集和阴道镜活检 ,用液基标本做薄片细胞学诊断和肿瘤相关人乳头瘤病毒 (humanpapillomavirus ,HPV)检测。细胞学诊断采用TBS分级系统 ,阳性诊断包括意义不明的不典型鳞状细胞 (ASCUS)以上病变 ,诊断结果与阴道镜活检诊断和肿瘤相关HPVDNA阳性检出率对照。所有检查均双盲进行。结果 ThinPrep液基细胞学检出 10 0 % (12 / 12 )的鳞状细胞癌 (SCC) ;93 .2 % (6 9/ 74)的鳞状上皮内高度病变 (HSIL) ,其中CIN3 96 .8% (30 / 31) ,CIN2 90 .7% (39/ 43) ;72 .4%(92 / 12 7)的鳞状上皮内低度病变 (LSIL)。SCC和CIN3的分级准确率分别达 10 0 %和 87.1%。HPVDNA阳性检出率与细胞学分级密切相关 ,且在细胞学与组织学相同级别基本一致。结论 宫颈液基标本收集方法有利于细胞学和肿瘤相关HPVDNA双重检查。ThinPrep液基细胞学检查敏感性高 ,尤其是对鳞状上皮内高度病变。

Objective To evaluate the efficacy of liquid based cytology (ThinPrep Pap Test) for cervical carcinoma screening in a high incidence area, Xiangyuan county of Shanxi province. Methods This study was performed on 1997 women residing in Xiangyuan county, a high incidence of cervical carcinoma. Exfoliative cervical samples and subsequent colposcopic biopsies were taken from all subjects. Cervical samples were collected into a liquid buffer for both ThinPrep Pap Test cytologic screening and human papilloma virus (HPV) DNA test. All tests were carried out independently and blindly of which the results were compared with those of HPV DNA detection and colposcopic biopsies. Results When the cytologic diagnosis of atypical squamous cells of determined significance (ASCUS) was taken as the detection threshold and compared with the “standard” biopsy, the ThinPrep slides were able to detect 100%(12/12) of squamous cell carcinoma (SCC) and 93.2% high grade squamous intraepithelial lesions (HSIL) which included 96.8% (30/31) CIN Ⅲ, 90.7% (39/43) CIN Ⅱ and 72.4%(92/127) low grade squamous intraepithelial lesions (LSIL). When cytologic diagnosis of HSIL was used as the detection threshold, the ThinPrep slides were able to detect 100% (12/12) SCC and 87%(27/31) CINⅢ.Conclusion Cervical specimens collected into a liquid buffer are suitable for both cytologic screening and human papilloma virus test. The ThinPrep cytology demonstrates a high sensitivity for the detection of high grade squamous intraepithelial lesions and squamous cell carcinoma.