宫颈液基薄层细胞学与组织学对比研究

Comparative study of cytological and histological thinprep

目的:探讨影响妇科液基薄层细胞学诊断一致性的因素。方法:2013年1月-2014年6月收集细胞学异常病例213例,将细胞学结果与组织学结果对照分析,复查液基细胞学及组织学切片,分析相符程度及误诊原因。结果:共3 010例受检者进行液基薄层细胞学检查,其中细胞学诊断为ASC-US 143例(4.75%),ASC-H 41例(1.36%),LSIL54例(1.79%),HSIL 25例(0.83%),SCC 7例(0.23%)。270例细胞学异常的病例其组织学诊断为LSIL、HSIL、SCC分别为92例、60例、20例,与细胞学符合率分别为77.8%、72%、71.4%。误诊的原因主要为取材部位不适当、放化疗反应、萎缩及反应性上皮、对低分化细胞学病变认识不足、某些细胞学片中缺乏典型病变特征。结论:妇科液基薄层细胞学对宫颈病变阳性预测值较高,但存在与组织学诊断结果不符合的情况,细胞学医师应提高诊断水平,临床妇科医师应充分认识避免造成不一致的因素。

Objective:To investigate the effect of gynecological liquid based cytology diagnosis consistency.Methods: 213 cases of cytological abnormalities were collected from January 2013 to June 2014.We analysed the cytology results and histological results, and reviewed the liquid based cytology and histological sections.We analyzed the consistent degree and the causes of misdiagnosis.Results:A total of 3 010 cases were investigated thinprep cytology.The cytological diagnosis of ASC-US in 143 cases(4.75% ),ASC-H in 41 cases(1.36% ),LSIL in 54 cases(1.79% ),25 cases were HSIL(0.83% ),SCC in 7 cases(0.23% ).The histological diagnosis of 270 cases of abnormal cytology were LSIL,HSIL,SCC were 92,60,20 cases respectively,and the coincidence rate with cytological was 77.8%,72%,71.4% respectively.The causes of misdiagnosis mainly as the materials and inappropriate,response to chemoradiotherapy,atrophy and reactive epithelium,low differentiated cytological lesions understanding insufficiency,some cytology film lack dian lesion characteristics.Conclusion:The value of gynecology of liquid based cytology in cervical lesions positive predictive is high, but there exist not meet to the histological diagnosis results situation.The cytological physicians should improve the level of diagnosis,and the clinical gynecologists should fully understand the factors that cause the inconsistency avoidance.