宫颈细胞学低级别鳞状上皮内病变的形态特征及其临床意义探讨

Study on morphological characteristics of low grade intraepithelial squamous lesions diagnosed by cervical cytology and their clinical significance

目的:探讨宫颈细胞学检查不同细胞形态学表现的低级别鳞状上皮内病变(low grade squamous intraepithelial lesion,LSIL)的临床意义。方法:对2017年7月至2018年6月宫颈细胞学诊断为LSIL同时行宫颈人乳头瘤病毒(human papilloma virus,HPV)分型检测、阴道镜及宫颈活检的153例病例结果进行回顾性分析。结果:宫颈细胞学检查不同细胞形态的LSIL患者高危型HPV(high risk human papilloma virus,HR-HPV)感染率均较高(81.0%),挖空细胞型LSIL为77.0%,非挖空细胞型LSIL为83.7%。其中异常细胞为非挖空细胞型LSIL患者的HPV16/18感染率为18.5%(17/92),明显高于挖空细胞型LSIL患者的6.6%(4/61)。非挖空细胞型LSIL患者的活检病理诊断≥宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅱ的检出率为28.3%(26/92),明显高于挖空细胞型LSIL患者的8.2%(5/61),差异均具有统计学意义(P<0.05)。结论:非挖空细胞型LSIL患者更可能存在或进展为CINⅡ及以上病变,更应该引起临床医生重视。

Objective:To investigate the clinical significance of low grade squamous intraepithelial lesions(LSIL) in different cell morphology by applying cervical cytology. Methods:Results of 153 patients diagnosed with LSIL by cervical cytology and underwent human papilomavirus(HPV) typing detection,colposcopy and cervical biopsy from July 2017 to June 2018 were retrospectively analyzed. Results:The LSIL patients with different cell morphology diagnosed by cervical cytology had high infection rates of high-risk HPV(HR-HPV)(81.0%);the infection rate of LSIL patients with koilocyte was 77.0%,while of LSIL patients with non-koilocytotic cell was 83.7%. Among them,the HPV16 and HPV18 infection rates of LSIL patients with abnormal cells being non-koilocytotic cell were18.5%(17/92),significantly higher than those of koilocyte type LSIL patients(6.6%,4/61). The detection rate of biopsy pathological diagnosis ≥ intraepithelial lesion of cervix(CIN) Ⅱ among LSIL patients with non-koilocytotic cells was 28.3%(26/92),significantly higher than that among LSIL patients with koilocyte type(8.2%,5/61),with were statistically significant differences(P<0.05). Conclusion:The LSIL patients with non-koilocytotic cells are more likely to have or progress into CIN Ⅱ and more severe lesions,therefore,clinicians should pay more attention to it.