312938例子宫颈脱落细胞学诊断的质量分析

Quality analysis of Papanicolaou smears of cervical exfoliative in cytology in 312938 women

目的 分析 312 938例按巴氏分类标准诊断的宫颈脱落细胞学涂片中的阳性病例与组织病理学诊断的对照情况 ,强调在现实条件下细胞学检查中质量控制的方法及其重要性。方法 资料来源于 1994年 1月～ 2 0 0 2年 12月我院门诊和住院患者的子宫颈脱落细胞学涂片 ,全部病例采用传统抹片方法 ,巴氏染色 ,诊断按巴氏Ⅴ级分类法 ,登记并随访细胞学诊断的阳性病例 ,并与同期组织病理学诊断档案对照。结果 9年中共检查宫颈脱落细胞涂片 312 938例 ,巴氏Ⅲ级及Ⅲ级以上病例共 6 93例 ,阳性检出率为 2 .2‰ ,其中 386例 (5 5 .7% )获得组织病理学诊断对照。 386例中 ,巴氏Ⅲ、Ⅳ和Ⅴ级与组织病理学的实际符合率分别为 6 1.6 %、87.3%和 89.2 %。总体假阳性率为 15 .8% ,巴氏Ⅲ、Ⅳ和Ⅴ级的假阳性率则分别为 19.8%、12 .7%和 4 .6 % ,总体假阴性率为 2 8.6 %。巴氏Ⅲ级病例除有较高的假阳性率外 ,同时存在较高比例的过度诊断和诊断不足 ,分别为 18.6 %和 36 .8%。进一步分析表明 ,造成较高比例假阳性率和过度诊断的主要原因是对人乳头瘤病毒 (HPV)感染性病变的认识不足。结论 传统的巴氏分类标准对于肿瘤性病变的准确性是可接受的 ,但对于HPV感染性病变易作出假阳性诊断或过度诊断。加强对巴氏Ⅲ级涂片的管理及随?

Objective To evaluate the quality control of Papanicolaou smears of the cervical cytology in 312 938 cases based on comparison of the histopathologic diagnoses and to emphasize the importance and quality assurance scheme of smeared cytology in clinical practice. Methods All individuals underwent Papanicolaou(Pap) smear with Pap staining. The cytodiagnosis was classified by the Papanicolaou smear. The positive cases were registered at the Department of Pathology of OBS & GYN Hospital affiliated to Fu Dan University. Results During January 1994-December 2002, 312 938 women underwent the Papanicolaou smear. 693 individuals were identified as positive, the positive rate was 2.2‰. Of these, 386 cases were compared with the controls by their histopathology. The sensitivities according to Class Ⅲ, Ⅳ and Ⅴ were 61.6%, 87.3% and 89.2%, respectively. The overall false positive rate was 15.8%. The false positive rates of Class Ⅲ, Ⅳ and Ⅴ were 19.8%, 12.7% and 4.6%, respectively and the overall false negative rate was 28.6%. Also, there were 18.6% overdiagnosed and 36.8% underdiagnosed in Class Ⅲ. The human papillary tumor virus(HPV) infection was accounted for the false positive and overdiagnosis in individuals of Class Ⅲ. Conclusion The accuracy rate of Papanicolaou Classification System for malignancies is acceptable, but it can lead to false positive and overdiagnosis in Class Ⅲ, which may be improved through administrative and follow-up examination of the positive cases.