宫颈LSIL的形态学特征及临床意义

The morphological characteristics and clinical significance of LSIL on cervix

目的探讨宫颈低度鳞状上皮内病变（LSIL）的形态学特征及临床意义。方法对我院2013年1月-2015年8月用宫颈液基细胞学（LCT）方法检出的298例LSIL,其中100例有活检或锥切或子宫全切组织学结果,对比细胞学与组织学两种检测结果的一致性;对结果不一致者进行原因分析。结果在100例LSIL中,组织学显示,低度病变67例,高度病变（HSIL）31例,慢性炎症、无明显湿疣者2例;对组织学证实为高度病变的31例进行回顾性阅片,液基细胞学涂片诊断重复性较好,有27例仍为LSIL病变,4例有分歧。结论组织学与细胞学结果不一致的原因可能如下：①存在明显挖空细胞的HSIL。②HSIL呈分化型改变。③LSIL和HSIL并存。④确属于＂不能明确分级的鳞状上皮内病变＂。对细胞学诊断为LSIL的病例,应建议进行阴道镜检查和宫颈活检,避免隐匿的高度病变被漏诊或失访;同时细胞学医师应尽可能全面、正确地评估涂片中细胞,避免出现诊断不足或过度诊断;尤其应正确认识宫颈细胞学检查的初筛作用,不能完全替代组织学检查。

Objective To study the morphological characteristics and clinical significance of low grade squamous intraepithelial lesions on cervix.Methods 298 patients of our hospital between Jan,2013 and Aug,2015 were cytologically diagnosed as LSIL.100 cases of them were treated with subsequent histological results of biopsy or leep cervix or hysterectomy.The diagnostic results were compared.Results Of the 100 cases,67were confirmed by low grade lesions histologically and 31 were histologically diagnosed as high grade.When cytologically reviewed the 31 cases histologically diagonsed as high grade lesions,there were 27 cases diagnosed as LSIL.Conclusion We should pay special attention to the cases cytologically diagnosed as LSIL,by putting forward appropriate recommendations such as reminding gynecologist colposcopic test and biopsy and avoiding dormant HSIL be missed diagnosis or losing follow-up.At the same time,diagnostician should be strictly following the criteria,and do his best to give a comprehensive assessment of the sample to avoid over-diagnosis or missed.Most of all,we should understand the preliminary screening function of cervical cytology correctly and cannot replace histological examination completely.