北京市大兴区宫颈癌筛查宫颈细胞学结果分析

Analysis of cervical cytology results in cervical cancer screening in Daxing District of Beijing

目的：了解北京市大兴区适龄妇女的生殖健康状况。方法对2013至2014年北京市大兴区35～64岁户籍妇女进行妇科及宫颈细胞学检查，记录个人基本信息、个人病史及检查结果。结果宫颈癌筛查39224人，进行传统巴氏细胞学检查的妇女共有25544人，阳性（未明确诊断意义的不典型鳞状上皮细胞及以上）检出率为2．22％。国产液基细胞学技术检查13680人，阳性检出率为2．84％。液基细胞学检查与巴氏涂片相比，不满意涂片率低，经比较差异有统计学意义（χ^2＝20．00，P＜0．01）。液基细胞学检查在癌前病变和癌的阳性检出率均高于巴氏涂片，主要体现在未明确诊断意义的不典型鳞状上皮细胞、鳞状上皮内低度病变、鳞状上皮内高度病变的阳性检出率高，差异均有统计学意义（χ^2值分别为6．78、6．68、5．83，均P＜0．01）。在细胞学结果为鳞状上皮内高度病变的51人中，有1人被最终确诊为宫颈癌，并且有22人最终诊断为宫颈上皮内瘤变。在细胞学结果为鳞状细胞癌的2人中，均被最终确诊为宫颈癌。结论宫颈细胞学检查在早期发现和及时治疗宫颈癌及癌前病变中起到了非常重要的作用，但由于阅片人员有限及其能力水平的问题，使得细胞学阅片结果阳性率偏低。

Objective To investigate the reproductive health status of women in Daxing District of Beijing.Methods From 2013 to 2014 women aged 35-64 years old accepted cervical cytological and gynecological examination, and personal basic information, personal history and examination results were recorded.Results Totally 39 224 women received cervical cancer screening and a total of 25 544 people received traditional pap cytological examination.The positive detection rate （ ASC-US and above） was 2.22%.Domestic technology of liquid based cytology check was performed among 13 680 people with positive detection rate of 2.84%.Compared with pap smear, unsatisfactory smears rate of liquid based cytology check was low, and the difference was significant （χ^2 =20.00, P〈0.01）.Liquid based cytological examination had higher positive detection rate of precancerous lesions and carcinoma than pap smear, especially in detecting the positive rate of ASC-US, LSIL and ASC-H （χ^2 value was 6.78, 6.68 and 5.83, respectively, all P〈0.01）.Among the 51 patients with cytological results of squamous intraepithelial lesions, one was eventually diagnosed with cervical cancer and 22 with cervical intraepithelial neoplasia.The two patients with squamous cell carcinoma were eventually diagnosed with cervical cancer.Conclusion Cervical cytological examination plays a very important role in early detection and timely treatment of cervical cancer and precancerous lesions.But due to the limited number of read personnel and limited ability, the positive rate of cytology reading results are low.