子宫颈细胞学不除外高度鳞状上皮内病变的不典型鳞状上皮细胞的临床病理学意义

Clinicopathological significance of atypical squamous epithelium cells which cannot exclude high-grade squamous intraepithelial lesions in cervical cytology

目的 探讨子宫颈细胞学不除外高度鳞状上皮内病变的不典型鳞状上皮细胞（ASC-H）在子宫颈疾病诊断中的意义.方法 对山西大医院2012年3月至2015年12月子宫颈液基细胞判读为ASC-H的496例患者的年龄、高危型人乳头瘤病毒DNA（hrHPV DNA）及子宫颈活组织检查结果进行分析.结果496例ASC-H患者中,年龄40～49岁患者比例最高,为30.8％（153/496）.154例进行了hrHPV DNA检测,阳性率为79.2％（122/154）,18～29岁患者的阳性率最高,为84.2％（16/19）.124例进行了子宫颈活组织检查,子宫颈上皮内瘤变（CIN）Ⅱ及以上病变的检出率为66.9％（83/124）;hrHPV DNA阳性100例（80.6％）,hrHPV DNA阴性24例（19.4％）.100例接受了子宫颈活组织检查的hrHPV DNA阳性患者中,CINⅡ、CINⅢ、早期鳞状细胞癌及鳞状细胞癌共71例（71.0％）;24例接受了子宫颈活组织检查的hrHPV DNA阴性患者中,CINⅡ、CINⅢ改变12例（50.0％）,但无一例早期鳞状细胞癌和鳞状细胞癌,与hrHPV DNA阳性患者比较,差异有统计学意义（χ2=3.857,P〈0.05）.hrHPV DNA检测对诊断CINⅡ及以上病变的阳性预测值、阴性预测值、灵敏度、特异度分别为85.5％、29.3％、71.0％、50.0％.结论子宫颈细胞学ASC-H高度提示存在CINⅡ及以上病变,hrHPV DNA检测对诊断CINⅡ及以上病变具有较高的阳性预测值.

Objective To investigate clinicopathological significance of atypical squamous epithelium cells which cannot exclude high grade squamous intraepithelial lesions （ASC-H） in the diagnosis of cervical diseases. Methods The results of age, high-risk human papillomavirus DNA （hrHPV DNA） and cervical biopsy in 496 patients with ASC-H from March 2012 to December 2015 in Shanxi Dayi Hospital were analyzed. Results Among 496 ASC-H cases, the proportion of the patients between 40 and 49 years old was the highest [30.8 ％ （153/496）]. HrHPV DNA was detected in 154 cases, and the positive rate was 79.2 ％（122/154）, and the positive rate of patients at the age of 18 to 29 years old was the highest [84.2 ％ （16/19）]. The detection rate of cervical intraepithelial neoplasia （CIN） Ⅱand above lesions in 124 cases with cervical biopsy was 66.9 ％ （83/124）, including 100 cases with hrHPV DNA positive （80.6 ％） and 24 cases with hrHPV DNA negative （19.4 ％）. There were 71 cases （71.0 ％） of CINⅡ, CIN Ⅲ, early squamous carcinoma and squamous cell carcinomas in 100 hrHPV DNA positive patients with cervical biopsy. There were 12 cases （50.0 ％） of CINⅡ/Ⅲ changes in 24 hrHPV DNA negative patients with cervical biopsy, but none in early squamous carcinoma and squamous cell carcinomas was detected, and there was a significant difference between hrHPV DNA positive and negative patients （χ2=3.857, P〈 0.05）. The positive predictive value, negative predictive value, sensitivity and specificity of hrHPV DNA detection for diagnosis of CINⅡand above lesions were 85.5 ％, 29.3 ％, 71.0 ％ and 50.0 ％, respectively. Conclusions ASC-H strongly predicts CINⅡand above lesions in cervical cytology. The detection of hrHPV DNA has a high positive predictive value for CINⅡand above lesions.