北京市2013年适龄妇女免费宫颈癌筛查宫颈细胞学阅片质量控制结果分析

Quality control analysis on cervical cytology of free cervical cancer screening for 35-64-year-old women in Beijing in 2013

目的探讨2013年北京市宫颈癌免费筛查获得的宫颈细胞学阅片的质量控制情况,并进行相关分析。方法自2013年在北京市16个区、县宫颈癌筛查机构接受宫颈癌免费筛查获取的286 781张宫颈涂片信息中,采用概率随机抽样法,随机抽取9 907张宫颈涂片进行质量控制结果分析。本研究以专家阅片结果作为宫颈细胞学诊断金标准,对传统巴氏涂片及液基细胞涂片的宫颈细胞学检出阳性率差异、各质量控制指标差异及涂片不满意率差异等进行统计学比较。结果 1液基细胞涂片的总检出阳性率、低度鳞状上皮内瘤变(LSIL)及高度鳞状上皮内瘤变(HSIL)的检出阳性率均较巴氏涂片高,且差异有统计学意义(2.41%vs 2.05%,χ2=39.885,P=0.000;0.58%vs 0.31%,χ2=113.772,P=0.000;0.14%vs0.11%,χ2=4.464,P=0.035)。2抽取进行质量控制结果分析的涂片中,巴氏涂片与液基细胞涂片的假阴性率、特异度及符合率比较,差异均无统计学意义(P>0.05);巴氏涂片假阳性率较液基细胞涂片低,而其灵敏度较液基细胞涂片高,且差异均有统计学意义(0vs 0.55%,χ2=18.342,P=0.000;100.00%vs75.00%,χ2=98.980,P=0.000)。3本组宫颈涂片中,涂片不满意率为4.17%(413/9 907),首要原因为染色偏浅和(或)结构不清(54.24%);其次为细胞量不足(43.09%)。因细胞量不足导致的不满意率,巴氏涂片较液基细胞涂片高(2.45%vs 1.44%),而因染色偏浅和(或)结构不清导致的不满意率,则为液基细胞涂片较巴氏涂片高(3.34%vs 0.26%),且差异均有统计学意义(χ2=12.452,93.311;P=0.000)。结论北京市宫颈癌免费筛查的宫颈细胞学检出阳性率有待进一步提高。建立完善的宫颈细胞学质量控制评价系统,对涂片的取材、制片及染色等环节加以控制,以提高涂片满意度及宫颈细胞学阅片质量。

Objective To analyze the data of cervical cytology quality control among women accepted free cervical cancer screening in Beijing in 2013. Methods Collected 286 781 cervical cytology smears information of free cervical cancer screening in medical screening units of 16 districts and counties in Beijing in 2013. Use probability random sampling method to get 9 907 cervical cytology smears for quality control analysis. Took the pathologists~ diagnosis as golden standards. Detection positive rate,various indicators of quality control and unsatisfactory rate of smears were compared statistically between traditional Pap smear and liquid-based cervical cytology smear. Results ① The total detection positive rate and the detection positive rate of low-grade squamous intraepithelial lesion（LSIL） and high-grade squamous intraepithelial lesion（HSIL） of liquid-based cytology smear were higher than those of traditional Pap smear, and the differences were statistically significant（2.41% vs 2.05%,X^2 =39. 885,P=0. 000;0.58% vs O. 31%,X^2 = 113. 772, P= 0. 000; 0. 14% vs 0. 11%,X^2=4. 464, P = 0. 035）. ② There were no significant differences between Pap smears and liquid-based cytology smears in false negative rate, specificity and coincidence rate （P〉0.05）. The false positive rate of Pap smears was lower than that of liquid - based cytology smears,while the sensitivity rate were higher, and the differences were statistically significant（0 vs 0. 55%, X^22= 18. 342,P=0. 000 ;100. 00 % vs 75.00% ,X^2 =98. 980,P=0. 000）.③The dissatisfaction rate of smears was 4. 17%（413/9 907） among 9 907 cervical cytology smears,and the primary reason was lighter dyeing and （or） unclear structure of cell （54.24 % ）, followed by the lack of cell mass（43.09 % ）. The dissatisfaction rate of Pap smears caused by lack of cell mass was higher than that of liquid-based cytology smears（2.45% vs 1.44%）,while the dissatisfaction rate of liquid-based cytology smears caused by lighter dyeing and（or） unclear structure of cell was higher than that of Pap smears （3.34% vs O. 26%） ,and the differences were statistically significant（x^2= 12. 452,93. 311;P=0. 000）. Conclusions Cervical cytology detection positive rate of free cervical cancer screening in Beijing need to be further improved. And it is necessary to establish a quality control evaluation system on cervical cytology,focusing on improvement of cells collection, cytology smear producing and drum dyeing,to improve satisfaction rate and quality of cervical cytology smears.