湖南某医院286例宫颈细胞学ASC-US诊断的处理及临床意义

Management and Clinical Significance of Cervical-Cytological Diagnosis of ASC-US of 286 Cases in one Hospital of Hunan

目的:探讨宫颈细胞学检查结果为ASC-US(未明确意义的不典型鳞状上皮细胞)的处理及临床意义。方法:对286例液基细胞学检查(TCT)诊断为ASC-US的患者同时行高危型HPV-DNA检测和阴道镜下活检。结果:286例宫颈细胞学ASC-US诊断中,HPV阳性207例,占72.4%(207/286);HPV阴性79例,占27.6%(79/286);病理检查结果为:207例HPV阳性ASC-US患者组中,炎症80例(38.6%)、尖锐湿疣59例(28.5%)、宫颈上皮内瘤变(CIN)65例(31.4%)、宫颈浸润癌3例(1.5%);79例HPV阴性ASC-US患者组中,炎症56例(70.9%)、尖锐湿疣16例(20.2%)、CIN 7例(8.9%)、未检出宫颈浸润癌。高危型HPV阳性ASC-US患者组中CIN的检出率(31.4%)明显高于阴性组(8.9%),且差异具有统计学意义。结论:对ASC-US患者的处理应给予足够的重视,HPV DNA检测可将CIN从ASC-US中有效地检出,从而减少经阴道镜下活检以明确子宫颈癌前病变的病例数。

Objective To discuss the management and clinical significance when cervical cytology results revealed atypical squamous cells of undetermined significance( ASC-US). Methods 286 patients who were diagnosed as ASC-US by Thinprep liquid based cytology test( TCT) were detected with high risk type HPV DNA testing and biopsy under colposcope at the same time. Results Among 286 cases diagnosed as ASC-US,there were 207( 72.4%) HPV positive cases and 79( 27. 6%) HPV negative cases. Pathological examination of 207 cases of HPV positive group showed that 80 cases( 38. 6%) were diagnosed as inflammation,59 cases( 28. 5%) were diagnosed as acuteness wet wart,65 cases( 31. 4%) were diagnosed as cervical intraepithelial neoplasia( CIN) and3 cases( 1. 5%) were diagnosed as the cervical invasive cancer. While pathological examination of 79 cases of HPV negative group showed that 56 cases( 70. 9%) were diagnosed as inflammation,16 cases( 20. 2%) were diagnosed as acuteness wet wart,7 cases( 8. 9%) were diagnosed as CIN and no case was diagnosed as the cervical invasive cancer. The detection rate of CIN in high risk type HPV positive group( 31. 4%) was significantly higher than that in high risk type HPV negative group( 8. 9%),and the difference had statistical significance. Conclusion Sufficient attentions should be paid to the treatment of patients with ASC-US. HPV-DNA detection could separate CIN from ASC-US and reduce the cases of cervical precancerous lesions which need to diagnose with biopsy under colposcope.