改良液基细胞试剂盒对早期宫颈癌筛查应用价值的对比研究

Values of Improved Liquid-based Cytology Kits in Screening Cervical Cancer

目的：对应用两种液基细胞试剂盒行宫颈液基细胞学检查（LCT）的结果进行对比分析,评价改良的液基细胞试剂盒制片检查在宫颈癌筛查中的敏感性和价值。方法：2010年1月至2011年12月宫颈液基细胞学检查16 217例,统计其中LCT（n=4 161）、改良LCT（n=12 056）的制片满意率和阳性检出率并行对比分析,细胞学诊断采用TBS分级系统,阳性诊断包括意义不明确的非典型鳞状上皮细胞以上病变,对其中部分阳性病例行阴道镜下活检对比。结果：改良LCT和LCT液基细胞制片细胞满意率分别为97.4%和97.3%,两者差异无统计学意义（χ~2=0.08,P〉0.05）,改良LCT基本满意率高于LCT（χ~2=14.97,P〈0.01）,而不满意率低于LCT（χ~2=23.34,P〈0.01）。改良LCT液基试剂盒LSIL检出率（0.9%）高于LCT液基试剂盒（0.5%）,两者相比差异有统计学意义（χ~2=4.05,P〈0.05）,改良LCT液基试剂盒HSIL检出率（0.4%）高于LCT液基试剂盒（0.2%）,两者相比差异有统计学意义（χ~2=5.87,P〈0.05）。改良LCT液基试剂盒与组织学活检对照符合率为：ASC-US 43.5%,ASC-H 84.6%,LISL 83.8%,HSIL 96.0%,与LCT比较差异均无统计学意义（P〈0.05）。结论：改良LCT液基细胞试剂盒的敏感性和特异性明显高于LCT液基细胞试剂盒,能提高宫颈癌前病变检出率。

Objective To compare the results of two kinds of liquid-based cytology kits in liquid-based cervical cytology test （LCT） and evaluate the sensitivity and clinical significance of improved liquid-based cytology kits for the screening of cer- vical cancer. Methods From January 2010 to December 2011, total 16 217 patients underwent LCT, in which 4161 cases tested by using liquid-based cytology kits and the other 12 056 by using improved liquid-based cytology kits.The smear sat- isfactory rates and the positive diagnostic rates of two liquid-based cytology kits were compared.The results were reported according to TBS standard built in 2001.Positive diagnosis includes atypical squamous cells of undetermined significance （ASC-US） and more lesions.Some cases with positive results received colposcopy and biopsy, and then compared the re- sults of fluid basal cellswith cervical biopsy.Results The smear satisfactory rate of improved LCT and LCT was 97.4% and 97.3%, respectively, which has no significant difference （X2 = 0.08, P〉OI05）.The basic satisfactory rate of improved LCT was obviously higher than that of LCT（X2 = 14.97, P〈O.01 ）, and the unsatisfactory rate was obviously lower than that of LCT（X2 = 23.34, P〈0.01 ） .The detection rates of improved LCT （ 0.9% ） was obviously higher than that of LCT （ 0.4% ） （X2 = 4.05, P〈0.05） for LSIL.The detection rate of improved LCT （0.4%） was obviously better than that of LCT（0.2% ） （X2= 5.87,P 〈0.05） for HSIL.The coincidence of improved LCT compared with histological examination was as follows：ASC-US 43.5%, ASC-H 84.6%, LISL 83.8% and HSIL 96.0%, which had no significance differences than compared with LCT （all P〈 0. 05）.Concluston The sensitivity and specificity of improved LCT are obviously higher than those of LCT, so it can im- prove the detection rate of precancerous cervical lesions.