一次性宫腔细胞刷结合细胞块技术在子宫内膜癌筛查中的临床应用

Clinical utility of intrauterine cell brush combined with cell block in screening of endometrial carcinoma

目的探讨一次性宫腔细胞刷结合细胞块技术在子宫内膜癌筛查中的应用价值。方法选择2019年1—12月在新疆医科大学附属肿瘤医院就诊拟行宫腔镜检查的患者199例。一次性宫腔细胞刷取得细胞学标本,宫腔镜检查及诊刮取得组织学标本,细胞学标本制成细胞块用于细胞学诊断。比较宫腔细胞刷结合细胞块技术与宫腔镜诊刮取材满意度。以及细胞块技术细胞学诊断的符合率、灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)及准确率。结果宫腔细胞刷结合细胞块技术标本满意度为95.5%,宫腔镜诊刮标本满意度为92.0%;在绝经后女性中二者满意度分别为96.0%和89.2%,差异无统计学意义(P>0.05)。宫腔细胞刷结合细胞块技术在正常子宫内膜中诊断符合率为96.0%;在良性病变中诊断符合率为96.1%;在子宫内膜不典型增生中诊断符合率为100%;在子宫内膜癌中诊断符合率为80.0%;总体诊断符合率为94.3%。宫腔细胞刷结合细胞块技术的灵敏度为82.3%(19/23),特异度为98.0%(148/151),PPV为86.4%(19/22),NPV为97.4%(148/152),准确率为96.0%(167/174)。结论一次性宫腔细胞刷结合细胞块技术可作为子宫内膜癌筛查的一个可靠方法。

Objective To explore the application value of intrauterine cell brush combined with cell block in screening of endometrial carcinoma.Methods A total of 199 patients in the hospital underwent hysteroscopy were selected.The endometrial cytological specimenswere obtainedby using intrauterine cell brush,and then hysteroscopy and curettage were used to obtain histological specimens.Cytological specimenswere used to prepare cell blocks for cytological diagnosis.The satisfaction rate of endometrial cell brush combined with cell block and curettage,the coincidence rate,sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accuracy rate of cytological diagnosis by cell block werecompared.Results The satisfaction rate of intrauterine cell brush combined with cell block was 95.5%,and curettage was 92.0%,whilethe satisfaction rates of them were 96.0%and 89.2%respectively in the postmenopausal women,and there is no significant difference between the two groups(P>0.05).The diagnostic coincidence rate of intrauterine cell brush combined with cell block in the normal endometrium,in the benign lesion,in the atypical hyperplasia,and inthe endometrial carcinoma were 96.0%,96.1%,100%and 80.0%respectively;the overall diagnostic coincidence rate was 94.3%.The sensitivity was 82.3%(19/23),the specificity was 98.0%(148/151),the PPV was 86.4%(19/22),the NPV was 97.4%(148/152),and the accuracy was 96.0%(167/174).Conclusion Intrauterine cell brush combined with cell block may be a method for endometrial cancer screening.