子宫颈上皮内瘤变筛查方法的综合评价

Systematic evaluation of the new screen methods of cervical intaepithelial neoplasm

目的 对宫颈上皮内瘤变 (CIN)筛查方法即宫颈涂片自动检测系统 (papnetcytologycomputertechnology ,CCT)和新柏氏程控超薄细胞检测系统 (thinpreppaptest,TPT)两种细胞学检查方法进行综合评价。方法 对因细胞学检查异常而行阴道镜下多点活组织检查 (活检 )及病理检查的 374例患者的临床资料进行回顾性分析。结果 细胞学检查诊断为炎症者 9 1% ,低度鳞状上皮内瘤变(LSIL) 4 3 3% ,高度鳞状上皮内瘤变 (HSIL) 2 0 3% ,可疑癌 1 9% ;经阴道镜下多点活检及病理检查 ,诊断为炎症者增加到 5 3 5 % ,CINⅠ减少到 17 9% ,CINⅡ、CINⅢ、原位癌占 2 5 4 % ,可疑早期浸润癌和浸润癌增加到 3 2 %。 2 5 4 %的细胞学不能明确诊断意义的不典型鳞状上皮病变中 ,5 2 6 % (5 0 /95 )为炎症或未见异常 ,4 7 4 % (45 /95 )为CINⅠ以上的病变。 374例患者中 ,行CCT检查者 188例 ,TPT检查者 186例 ,两种细胞学检查结果分别与阴道镜检查结果相比 ,TPT的符合率显著高于CCT(P<0 0 1)。细胞学检查诊断为LSIL及以下病变的符合率 (79 7% )显著高于诊断为HSIL以及癌变者的符合率 (2 0 3% ) ,两者比较 ,差异有显著性 (P <0 0 1) ,而两种细胞学检查方法间无差别。人乳头状瘤病毒 (HPV)感染的发生率为 34 0 % 。

Objective To evaluate new cytologic screening methods of papnet cytology computer technology (CCT) and thinprep pap test (TPT) on cervical intraepithelial neoplasm (CIN). Medthods Three hundred and seventy four cases with abnormal cervical cytologic results received colposcopic examinations and mutiple biopsies. The results of cytologic screening compared with the results of histologic colposcopic diagnosis were analysed retrospectively. Results A total of 374 cases were diagnosed by cytology, 9 1% with inflamations, 43 3% with low grade squamous intraepithelial lesion (LSIL) and 20 3% with high grade squamous intraepithelial lesion (HSIL) and 1 9% suspected with squamous cell carcinoma. However, after examination by colposcopy and multiple biopsies, the situation was different. The percentage of cases with inflammation increased to 53 5%, cervical intraepithelial neoplasm Ⅰ (CIN Ⅰ) decreased to 17 9%, CIN Ⅱ and CIN Ⅲ and cervical carcinoma in situ (CIS) elevated to 25 4% and invasive squamous cell carcinoma increased to 3 2%. Among cases with atypical squamous cell of undetermined significance (ASCUS), 52 6%(50/95) were with inflamations or negative results, 47 4% (45/95) with CIN Ⅰ or even greater. Among 374 cases, 188 women were screened by CCT and 186 by TPT. When all cytological findings compared with the histologic colposcopic results, respectively, the coincidence of TPT with histologic colposcopic results was signficantly higher than that of CCT ( P <0 01). The coincidence rate (79 7%) of screening cases with LSIL or inflammation was significantly higher than that (20 3%) of cases with HSIL or even greater ( P <0 01). But there was no difference between two methods. The incidence of human papillomaviral infection (HPV) infection at colposcopies was 34 0%. The high incidences of HPV and CIN infection were found among women from 20 to 30 years old and from 30 to 50 years old, respectively. Conclusions Cases with abnomal cytologic findings should undergo colpscopic examination and mutiple biopsies for further diagnosis. Only in this way, cases with CIN or HPV infection could not be misdiagnosed. Women ranged from 30-50 years old should receive cytologic screening or colposcopic examination regularly.