宫颈液基细胞块联合免疫组化在宫颈癌筛查中的应用价值

The application value of cervical liquid-based cell blocks combined with immunohistochemistry in cervical cancer screening

目的:探讨宫颈液基细胞块联合免疫组化(IHC)在宫颈癌筛查中的应用价值。方法:对239例HPV及宫颈液基细胞学双阳性的残留标本进行细胞块制作、石蜡切片、免疫组化染色。观察其病理及免疫表型特征,并分析其应用价值。结果:液基细胞学被诊断为非典型鳞状细胞,意义不明(atypical squamous cells of undetermined significance,ASC-US)的90例标本中,经细胞块再确诊分流为低级别鳞状细胞上皮内病变(low-grade squamous intraepithelial lesions,LSIL)39例、高级别鳞状细胞上皮内病变(high-grade squamous intraepithelial lesions,HSIL)17例、宫颈腺癌1例及炎性/未见上皮内病变33例。细胞学诊断为LSIL的87例标本中,经细胞块确诊分流:LSIL 79例、炎性/未见上皮内病变8例。细胞学诊断为非典型鳞状细胞,不排除肿瘤病变(atypical squamous cells not excluding neoplastic lesions,ASC-H)的20例中,经细胞块确诊分流:LSIL 2例、HSIL 15例、鳞癌(squamous cell carcinoma,SCC)1例及炎性/未见上皮内病变2例。液基细胞学诊断为HSIL的32例中,细胞块确诊分流:HSIL 24例、SCC 6例及炎性/未见上皮内病变2例。液基细胞学诊断为腺细胞非典型增生(atypical glandular cells,AGC)的10例中,细胞块确诊分流:宫颈腺浸润性腺癌2例,子宫内膜腺癌1例。结论:宫颈液基细胞块联合IHC在宫颈病变及宫颈癌筛查中具有很好的应用价值,能有效分流细胞学中一些诊断不明确的病例,从而提高宫颈病变诊断准确性。是对宫颈液基细胞学及HPV检测的有效补充。

Objective:To investigate the application value of cervical liquid-based cell blocks combined with immunohistochemistry(IHC)in cervical cancer screening.Methods:Cell blocks were prepared,paraffin-embedded,and subjected to immunohistochemical staining from 239 cases with dual-positive results for HPV and cervical liquid-based cytology.The pathological and immunophenotypic characteristics were observed and analyzed for their application value.Results:Among the 90 cases diagnosed with atypical squamous cells of undetermined significance(ASC-US)by liquid-based cytology,cell block re-diagnosis revealed 39 cases of low-grade squamous intraepithelial lesions(LSIL),17 cases of high-grade squamous intraepithelial lesions(HSIL),1 case of cervical adenocarcinoma,and 33 cases of inflammation/no intraepithelial lesion.Among the 87 cases diagnosed with LSIL by cytology,cell block re-diagnosis showed 79 cases of LSIL and 8 cases of inflammation/no intraepithelial lesion.In 20 cases with cytological diagnosis of atypical squamous cells not excluding neoplastic lesions(ASC-H),cell block re-diagnosis revealed 2 cases of LSIL,15 cases of HSIL,1 case of squamous cell carcinoma(SCC),and 2 cases of inflammation/no intraepithelial lesion.Among the 32 cases diagnosed with HSIL by liquid-based cytology,cell block re-diagnosis showed 24 cases of HSIL,6 cases of SCC,and 2 cases of inflammation/no intraepithelial lesion.Among the 10 cases diagnosed with atypical glandular cells(AGC)by liquid-based cytology,cell block re-diagnosis revealed 2 cases of invasive cervical adenocarcinoma and 1 case of endometrial carcinoma.Conclusion:Cervical liquid-based cell blocks combined with IHC have excellent application value in cervical lesion and cervical cancer screening.They can effectively triage cases with unclear diagnoses in cytology,thereby improving the accuracy of cervical lesion diagnosis.They are a valuable supplement to cervical liquid-based cytology and HPV testing.