Diagnostic value of liquid-based cytology and smear cytology in pancreatic endoscopic ultrasound-guided fine needle aspiration: A meta-analysis

BACKGROUND Smear cytology(SC)using endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)is the established and traditional choice for diagnosing pancreatic lesions.Liquid-based cytology(LBC)is a novel alternative cytological method,however,the comparative diagnostic efficacy of LBC remains inconclusive.AIM To examine the diagnostic efficacy of LBC and SC for pancreatic specimens obtained through EUS-FNA via a systematic review and meta-analysis.METHODS A systematic literature search was performed using PubMed,EMBASE,the Cochrane Library,and Web of Science.The numbers of true positives,false positives,true negatives,and false negatives for each cytological test(LBC and CS)were extracted from the included studies.The pooled sensitivity and specificity and the area under the summary receiver operating characteristic curve(AUC)were calculated,and the AUC was compared by Tukey's multiple comparisons test.The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies II tool.RESULTS A total of 1656 patients in eight studies were included.The pooled sensitivity and specificity and the AUC for LBC were 0.76(95%CI:0.72-0.79),1.00(95%CI:0.98-1.00),and 0.9174,respectively,for diagnosing pancreatic lesions.The pooled estimates for SC were as follows:Sensitivity,0.68(95%CI:0.64-0.71);specificity,0.99(95%CI:0.96-100.00);and AUC,0.9714.Similarly,the corresponding values for LBC combined with SC were 0.87(95%CI:0.84-0.90),0.99(95%CI:0.96-1.00),and 0.9894.Tukey’s multiple comparisons test was used to compare the sensitivities and AUCs of the three diagnostic methods;statistically significant differences were found between the three methods,and LBC combined with SC was superior to both LBC(P<0.05)and SC(P<0.05).The pooled sensitivity and AUC did not change significantly in the sensitivity analysis.CONCLUSION LBC may be sensitive than SC in the cytological diagnosis of pancreatic lesions,however,the superior diagnostic performance of their combination emphasizes their integrated usage in the clinical evaluation of pancreatic lesions.

Comparison of smear cytology with liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis

BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)is a safe and accurate technique to confirm the diagnosis of pancreatic cancers.Recently,numerous studies comparing the diagnostic efficacy of smear cytology(SC)and liquid-based cytology(LBC)for pancreatic lesions yielded mixed results.AIM To compare and identify the better cytology method for EUS-FNA in pancreatic lesions.METHODS A comprehensive search of PubMed,Embase,and Cochrane was undertaken through July 18,2020.The primary endpoint was diagnostic accuracy(sensitivity and specificity).Secondary outcomes included sample adequacy and post procedure complications.In addition,factors affecting diagnostic efficacy were discussed.RESULTS Data on a total of 1121 comparisons from 10 studies met the inclusion criteria.Pooled rates of sensitivity for SC and LBC were 78%(67%-87%)vs 75%(67%-81%),respectively.In any case,both SC and LBC exhibited a high specificity close to 100%.Inadequate samples more often appeared in LBC compared with SC.However,the LBC samples exhibited a better visual field than SC.Very few post procedure complications were observed.CONCLUSION Our data suggested that for EUS-FNA in pancreatic lesions(particularly solid lesions),SC with Rapid On-Site Evaluation represents a superior diagnostic technique.If Rapid On-Site Evaluation is unavailable,LBC may replace smears.The diagnostic accuracy of LBC depends on different LBC techniques.

Comparative Study of Cell Findings by Conventional Smear and Liquid-Based Cytology for Oral Exfoliative Cytology

Background: Liquid-based cytology (LBC) is a method of manufacturing cyto-diagnostic specimens. Improved accuracy is expected from standardizing specimen production and use of this method is rapidly spreading in oral cytology. On the other hand, LBC reportedly requires training to show peculiar cell findings compared to those of conventional smear cytology (CVC). Few studies have compared detailed cell findings for oral CVC and LBC. Objectives: The aim of this study was to compare cytological findings between CVC and LBC using cytomorphological image analysis. Materials and Methods: Cytological specimens were collected from 20 patients (negative for squamous neoplasia in 10, dysplasia in 5, squamous cell carcinoma in 5) and 5 controls of the tongue between January 2017 and December 2018. Two different preparation techniques were investigated cytomorphologically for CVC and LBC (BD CytorichTM). Results: LBC showed significantly higher cell numbers than CVC for all lesions. LBC-to-CVC ratio ranged from 9.52 (hyperkeratosis) to 1.87 (deep cells in oral squamous cell carcinoma (OSCC)). Nuclear area of normal, hyperkeratosis, and inflammation were significantly higher in LBC than those of CVC. Hyperchromasia was significantly more frequent with CVC than with LBC for hyperkeratosis, inflammation, dysplasia and OSCC. There was no significant difference in circularity between CVC and LBC among all lesions. Conclusion: Only one cytomorphological disadvantage was seen with LBC, in the form of decreased hyperchromasia. Further clarification of the advantages and disadvantages of LBC is needed, including management of precision and screening practices.

Vaginal Intraepithelial Neoplasia Detected with Cervical Liquid-Based Cytology: Old Concerns or New Facilities?

Background: The detection of vaginal intraepithelial neoplasia (VAIN) in cervical samples is not a common finding. Therefore, we aimed to report VAINs detected in liquid-based cytology (LBC) from women examined at Hospital das Clínicas of Faculty of Medicine, Sao Paulo State University. Materials and Methods: We evaluated LBC samples from women referred to gynecology examination for different reasons (previous abnormal PapTest, follow up of treated cervical lesion, ecc) and women examined for regular screening proposals, and compared with biopsy diagnoses, including the controversial diagnoses of vaginal intraepithelial neoplasia (VAIN). Results: From 1866 patients, 1423 (76.3%) cases were negative and 443 (23.7%) were positive for any cellular alteration. Age of patients ranged from 12 to 86 years. We detected 25 histologically confirmed VAIN (1.3% p = 0.0002 by Fisher’s exact test IC 95% 0.0090 - 0.0198) and 1.1% VAIN (p = 0.0031 by Fisher’s exact test IC 95% 0.0077 - 0.0179). Conclusion: The identification of VAIN in routine is feasible;the professionals involved with cytological examination should be aware of these lesions in Pap test samples.

Research of cervical cytology screening in diagnosis of 370,000 cases with cervical lesion in Guangdong

Objective： Analysis of the results of 37 million cases by using cervical liquid-based cytology screening, discussion the situation of cervical cancer and precancerous lesions in Guangdong province. Methods： From 2002 to 2006, using liquid-based thin-layer cytology （TCT） method screening cervical lesions within 371,929 women in Guangdong. Cytological diagnosis adopt TBS （the Bethesda system） Standard （TBS improved 2001 version of the diagnostic criteria）, statistic positive rate by age and region respectively. Results： 371,929 cases of gynecology cervical samples in Guangdong, 331,251 cases were negative, accounted for 91.23%; cytology positive cases： 32,548 cases were squamous intraepithelial lesions （8.96%）, 486 cases were glandular epithelial lesions （0.13%）; grouped according to age： 30 to 40-year-old positive rate was 9.13%, 40 to 50-year-old positive rate was 9.60%, the latter had higher cytology positive rate; grouped according to region： the total samples in PRD areas were 304.951 cases, accounted for 81.99%, in which 24301 cases were positive （8.14%）, in 66978 cases （18.01%） of NON-PRD regions, 7645 cases were positive （11.87%）, there were 1858 cases had biopsy/follow-up results from 2004 to 2005, and the rate was 2.88%. Conclusion： The cytological positive rate of cervical cancer and its precancerous lesions was 9.09% in Guangdong （of which the rate of cytological diagnosis as precancerous lesions was 3.40%）, 30 to 50 age group had the high incidence of cervical cancer and its precursor lesions, and also the main stage of prevention for cervical cancer. Cytology positive rate was 11.87% in economic underdevelopment Non-Pearl River Delta regions, much higher than the Pearl River Delta region.

Effectiveness of Co-Testing in Cervical Cancer Screening Program in Macao SAR

Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.

Study on the Correlation between Human Papillomavirus and Mycoplasma genitalium Combined with TCT Detection

Objective: This study aims to explore the correlation between human papillomavirus (HPV) and Mycoplasma genitalium (CT) combined with TCT detection in cervical cancer screening. Method: A cross-sectional study design was adopted, and a total of 609 women who came to seek medical treatment were recruited as the study subjects. Combination testing was evaluated on cervical cancer screening by testing the women for HPV, CT with TCT detection and analyzing the relationship of cervical lesions with HPV and CT infection. Results: The study results showed that 21.57% of the subjects were infected with both HPV and CT, and 48.42% of the cases had abnormal TCT results at the same time. Further data analysis showed that HPV infection was significantly associated with abnormal TCT outcomes (p < 0.05), suggesting a possible synergistic effect of the two infections in cervical lesions. The combined sensitivity and specificity of HPV, CT and TCT detection were 21.57% and 48.42%, respectively, which were significantly higher than that of single detection. Conclusion: In summary, the results of this study support the importance of combined HPV, CT, and TCT testing in cervical cancer screening, and propose the hypothesis that combined testing may improve screening effectiveness. However, further large sample studies are needed to confirm this conclusion and explore the prospects of combined testing in clinical practice.

Case Report:Liquid-based cytology aids in primary fallopian tube cancer diagnosis

Primary fallopian tube carcinoma(PFTC) is a rare malignant carcinoma among all genital tract malignancies.It occurs most commonly in postmenopausal women and is similar to ovarian malignancy historically and clinically.Because of its insidious onset and silent course,the diagnosis is made usually postoperatively.Liquid-based cytology(LBC) is a type of method for cervical cancer screening,but sometimes it may aid in making PFTC diagnosis.We report a 47-year-old woman with PFTC,whose diagnosis was made with the aid of LBC.

人工智能辅助宫颈细胞学诊断技术的应用及质量控制专家共识

宫颈癌是严重威胁广大女性身心健康的恶性肿瘤之一,目前宫颈癌筛查方法主要包括人乳头瘤状病毒(HPV)核酸检测和细胞学检查。HPV检测阳性者通常需要进一步的细胞学等检查进行分流。HPV检测和细胞学联合筛查也需要细胞学医生的参与。在我国各地区适龄女性宫颈癌组织性筛查工作实施过程中,发现细胞学医生数量和能力的缺乏尤其是基层地区的缺乏是影响宫颈细胞学异常检出率的重要因素。人工智能(AI)辅助宫颈细胞学诊断技术已经开始试点应用于宫颈癌检查项目工作中,为了高质量地开展宫颈癌筛查工作,规范AI辅助宫颈细胞学诊断技术在宫颈癌检查项目中的应用,以及对提供相关项目的机构进行质控,保障宫颈癌检查项目尤其是人群组织性筛查的工作质量,助力我国《加速消除宫颈癌行动计划(2023—2030年)》,最终达到降低宫颈癌发生率和死亡率的目的,中国妇幼保健协会妇女病防治专业委员会特组织相关专家编写了本共识,主要内容包括AI辅助宫颈细胞学诊断技术的定义、AI辅助宫颈细胞学检查系统的要求、AI辅助宫颈细胞学诊断技术的应用和质量控制。

人工智能辅助系统在宫颈液基细胞学分析中的应用价值研究

目的探讨人工智能(artificial intelligence,AI)辅助系统在宫颈薄层液基细胞学检查分析中的应用价值。方法收集2020年1~8月在陕西省人民医院行宫颈细胞学检查的620例液基病例,其中经膜式薄层液基细胞学(thinprep cytology test,TCT)制片技术制片426例,经沉降法液基细胞制片技术(liquid-based cytology technology,LCT)制片194例。同时由病理科中级医师及AI辅助系统阅片,以高级医师审核结果为最终结果进行对比分析。结果中级医师在TCT组及LCT组中的分类判读结果与高级医师审核结果相比较,其差异均无统计学意义(χ^(2)=0.594,1.014,P=0.898,0.602)。AI辅助系统在TCT组及LCT组中的分类判读结果均与高级医师审核结果不一致,其差异具有统计学意义(χ^(2)=104.267,26.349,均P<0.001)。AI辅助系统在TCT,LCT两种制片方式中对阳性片的检测灵敏度分别为100%和83.33%,高于中级医师(86.36%,66.67%),其差异无统计学意义(χ^(2)=3.220,0.444,P=0.233,1.000);两种制片方式AI辅助系统判读特异度为65.10%和84.57%,均低于中级医师(99.26%,100%),差异具有统计学意义(χ^(2)=160.931,31.424,均P<0.001);准确度为66.90%和84.54%,均低于中级医师(98.59%,98.97%),差异具有统计学意义(χ^(2)=149.831,24.829,均P<0.001)。结论AI辅助系统在TCT及LCT两种制片方式中灵敏度与中级医师相似,有利于阳性病例的筛出,但准确度及特异度较低,需要结合高级医师审核结果以提高准确度。

肺泡灌洗液液基薄层细胞学制片技术对肺癌的诊断价值

目的探讨肺泡灌洗液传统细胞学与液基薄层细胞学(liquid-based thin-preparation cytologic test,LCT)制片技术对肺癌的诊断价值。方法收集2020年1月至2022年8月厦门大学附属第一医院收治的肺癌患者106例,采用两种方法对其肺泡灌洗液进行细胞学制片,比较传统细胞学与LCT制片技术在阳性检出率、制片质量及阅片时间方面的差异。结果肺泡灌洗液LCT制片技术的阳性检出率为98.1%,高于传统方法的91.5%;LCT制作的涂片厚薄适当,分布均匀,细胞结构清晰,核质对比分明,无人工假象,封固适当,优于传统涂片;肺泡灌洗液LCT涂片的制片质量得分为9.06±0.06分,显著高于传统涂片的7.11±0.09分;肺泡灌洗液LCT涂片的阅片时间为27.15±0.42 s,显著短于传统涂片的92.27±1.06 s。结论肺泡灌洗液LCT制片技术相较于传统涂片技术在诊断肺癌方面具有更高的应用价值。

人工智能宫颈癌实时筛查系统TruScreen在宫颈癌筛查中的作用研究

目的探讨人工智能宫颈癌实时筛查系统TruScreen(TS)在宫颈癌筛查中的临床应用价值。方法回顾性分析2019年12月至2020年12月于我院妇科门诊进行宫颈癌筛查的997例受检对象的临床资料,所有研究对象均进行了TS检测、人乳头瘤病毒(HPV)检测、液基薄层细胞学(TCT)检测。3种筛查方法中有任何1种异常者行阴道镜检查,阴道镜下有病变的患者均行宫颈活检。以组织病理学结果为诊断标准,比较3种方法单独筛查及TS+HPV联合筛查、TCT+HPV联合筛查的灵敏度、特异度、阳性预测值、阴性预测值及受试者工作特征曲线下面积(AUC)。结果纳入的997例受检对象平均年龄(35.42±8.47)岁。131例患者行宫颈活检术,病理结果异常[低级别鳞状上皮内病变(LSIL)及以上]共59例,其中TS检测阳性率为86.44%(51/59),HPV检测阳性率为94.92%(56/59),TCT检测阳性率为89.83%(53/59)。以组织病理结果[高级别鳞状上皮内病变(HSIL)及以上]为标准,TS检测的灵敏度为88.24%、特异度为58.76%,AUC为0.735;TCT检测的灵敏度为47.06%、特异度为70.10%,AUC为0.586;HPV检测的灵敏度为94.12%、特异度为36.08%,AUC为0.651;TS+HPV联合检测的灵敏度为97.06%、特异度为87.63%,AUC为0.588;TCT+HPV联合检测的灵敏度为91.18%、特异度为98.96%,AUC为0.598。结论TS检测用于宫颈癌筛查有较好的效果,具有一定的临床应用价值。

低深度全基因组测序技术联合细胞学检测在高龄产妇产前诊断中的应用

目的 探讨低深度全基因组测序技术(CNV-seq)联合细胞学检测在高龄产妇产前诊断中的应用。方法 选取2020年1月至2021年12月濮阳妇幼保健院进行产前检查且经重复无创筛查无效的196例的高龄产妇作为研究对象,所有产妇先行羊膜腔穿刺术,对胎儿羊水样本进行细胞学检测及CNV-seq检测,分析比较两种技术检出胎儿染色体异常结果,并随访其妊娠结局。结果 细胞学检测检出异常40例,异常率20.40%;CNV-seq技术检出异常52例,异常率26.53%;两者单独检出异常率比较,差异无统计学意义(χ^(2)=2.045,P>0.05);细胞学检测+CNV-seq检测检出异常65例,异常率33.16%,细胞学检测、CNV-seq检测与细胞学检测+CNV-seq检测比较,差异有统计学意义(χ^(2)=8.151,P<0.05)。结论 低深度全基因组测序技术联合细胞学检测在高龄产妇产前诊断中有良好的应用价值,且具有较高的检出率。

北京市宫颈癌筛查宫颈细胞学机构事前质控评估方法及结果分析

目的探索建立宫颈癌筛查宫颈细胞学机构事前质控评估方法 ,并用该方法对参与北京市宫颈癌免费筛查的宫颈细胞学检查机构进行事前质控评估,掌握机构服务现况及存在问题,筛选出宫颈细胞学产品、制片、阅片质量良好的机构,参与北京市宫颈癌免费筛查,提高筛查质量。方法采用资料审核、现场评价两种方法对影响细胞学检查质量的机构资质、硬件条件、制度、保存液质量、制片操作流程、人员能力等进行综合评价,筛选出宫颈细胞学产品、制片、阅片质量良好的机构。结果 16家机构参与了事前质控。通过专家组统一对资料进行审核剔除资料不全、字迹模糊、无相关资质、不符合技术要求的机构,最终6家机构5种产品进人现场评价阶段。保存液质量评估发现1家机构的产品不合格;2家机构的保存液取材后应在1周内尽快制片;2家机构的保存液可以4周内完成制片。现场评价基本具备承担筛查的硬件条件,但细胞学检查机构制度不健全,5家机构制订了质控方案,5家机构未对可疑病例进行追访;检查机构间人员的阅片能力有差异,人员阅片考核的平均分为64.6分;细胞学检查机构阅片质量复核符合率为95%,制片的操作流程欠规范。结论通过事前质控评估方法 ,筛选出了合格的细胞学检査机构及产品,要求各区从评估合格的机构中择优选择承担本区宫颈癌免费筛查中宫颈细胞学检测工作。同时通过评估发现宫颈细胞学检查机构管理及操作欠规范,阅片人员的技能需加强。下一步将针对存在问题,组织统一培训,规范服务流程,加强对筛选合格机构的日常监管和内部质控,不断提高筛查质量和技术水平。

痰切片检测痰脱落细胞在肺癌诊断中的应用

目的:探讨在统一护理指导方法下留取痰标本并使用痰切片检测痰脱落细胞对肺癌诊断的意义。方法:在统一护理指导方法下留取痰标本,然后对350例痰标本进行痰切片和传统涂片方法检测。结果:350例痰标本检出恶性肿瘤细胞36例,经组织学证实痰切片检出阳性率为59%(36/61),分型符合率95%(34/36),传统涂片检出阳性率44%(27/61),分型符合率67%(18/27)。阳性率及分型符合率,差异均有统计学意义(P<0.05)。结论:在痰脱落细胞检测肺癌时痰切片方法的阳性检出率及分型符合率高于传统涂片方法,二者联合运用可提高检测的灵敏度。

液基细胞学涂片法检测痰抗酸杆菌对肺结核的诊断价值

目的探讨液基细胞学涂片法检测痰抗酸杆菌对肺结核的诊断价值。方法选择新乡医学院第一附属医院结核内科2017年6~8月收治的251例肺结核患者为研究对象,留取所有患者的夜间痰、晨痰、即时痰各1份,采用液基细胞学涂片法、直接涂片法和罗氏培养法检测痰抗酸杆菌,比较3种方法对痰抗酸杆菌的阳性检出率;并以罗氏培养法为金标准,比较直接涂片法和液基细胞学涂片法检测痰抗酸杆菌诊断肺结核的灵敏度及特异度。结果直接涂片法、液基细胞学涂片法和罗氏培养法对晨痰抗酸杆菌的阳性检出率高于夜间痰和即时痰(χ~2=7.492、18.323、4.111、19.443、4.349、18.305,P<0.05)。液基细胞学涂片法、罗氏培养法检测夜间痰、晨痰、即时痰抗酸杆菌的阳性检出率高于直接涂片法(χ~2=8.690、5.024、4.594、11.288、7.386、7.571,P<0.05);液基细胞学涂片法检测夜间痰、晨痰、即时痰抗酸杆菌的阳性检出率与罗氏培养法比较差异无统计学意义(χ~2=0.179、0.232、0.392,P>0.05)。直接涂片法、液基细胞学涂片法和罗氏培养法对血痰抗酸杆菌的阳性检出率高于脓性痰、黏液痰、唾液痰(χ~2=4.102、43.867、28.275、4.107、76.758、31.772、4.214、56.033、27.490,P<0.05)。液基细胞学涂片法、罗氏培养法对脓性痰、血痰、黏液痰、唾液痰抗酸杆菌的阳性检出率高于直接涂片法(χ~2=9.814、11.943、5.061、4.174、4.103、8.361、26.054、23.941,P<0.05);液基细胞学涂片法检测脓性痰、血痰、黏液痰、唾液痰抗酸杆菌的阳性检出率与罗氏培养法比较差异无统计学意义(χ~2=0.106、0.045、1.539、0.056,P>0.05)。以罗氏培养法作为金标准,直接涂片法检测痰抗酸杆菌的灵敏度和特异度分别为40.33%、94.41%,液基细胞学涂片法检测痰抗酸杆菌的灵敏度和特异度分别为70.72%、93.18%,液基细胞学涂片法检测痰抗酸杆菌的灵敏度高于直接涂片法(χ~2=33.507,P<0.05),液基细胞学涂片法与直接涂片法检测痰抗酸杆菌的特异度比较差异无统计学意义(χ~2=0.237,P>0.05)。结论液基细胞学涂片法检测痰抗酸杆菌阳性检出率、灵敏度和特异度高,且生物安全性好。

膜式和沉降式宫颈液基细胞学制片方法的比较研究

目的分析评价膜式和沉降式宫颈液基细胞学制片方法和质量,以寻求提高宫颈液基细胞学制片质量的方法。方法对我院妇产科送检的液基细胞学标本310份行相关处理后加入原细胞保存液1倍体积的保存液,充分振荡后取一半标本保存液置入另一个干净的保存瓶中。2瓶标本保存液分别按照膜式和沉降式两种制片方法制作涂片,所有涂片均经95%乙醇固定后行改良巴氏染色,并于肉眼及光学显微镜下观察染色情况。结果肉眼观察膜式法所制涂片细胞分布不均,涂片周围细胞较多或较厚,部分区域细胞缺如或过厚;沉降式法所制涂片细胞分布均匀,有时细胞较厚,偶见较大细胞团块沉积。光学显微镜下见膜式法制作的涂片背景干净,细胞分布不均匀,涂片周围细胞较多或重叠严重,部分区域细胞缺如或重叠较多,有些细胞固缩明显,红细胞或炎细胞污染较少,染色不鲜艳;沉降式法制作的涂片背景尚干净,细胞分布均匀,有时细胞层次较多,细胞固缩或重叠较少,偶有红细胞或炎细胞污染,染色鲜艳。结论本研究中沉降式法制作宫颈液基细胞学涂片可控性较膜式法好,制片质量较高。

子宫内膜采集器、液基细胞学、细胞模块在子宫内膜癌及癌前病变筛查中的联合应用

目的:探讨子宫内膜采集器、液基细胞学、细胞模块技术在子宫内膜癌及癌前病变诊断中的应用价值。方法:2014年1月至2015年1月,305例在我院门诊需要进行子宫内膜检查的患者行子宫内膜采集器取材、诊断性刮宫,用液基细胞学、细胞模块方法进行细胞学检查,并与诊断性刮宫组织学检查结果比较。结果:液基细胞学与病理金标准诊断结果比较:诊断子宫内膜非典型增生的灵敏度为55%、特异度为82.6%、Youden指数是37.6%,诊断子宫内膜癌的灵敏度为36.4%、特异度为99.7%、Youden指数是36.1%。细胞模块制片法与金标准结果比较:诊断子宫内膜非典型增生中灵敏度为70%、特异度为90.2%、Youden指数是60.2%,诊断子宫内膜癌灵敏度为54.55%、特异度为98.63%、Youden指数是53.2%。结论:应用子宫内膜细胞采集器取材,行液基细胞学检查、细胞模块制片,可用于筛查症状人群及高危人群子宫内膜病变,但在细胞学检查过程中的诊断技术及取材工具还有望于提高。

4200例LPT液基薄层细胞学检查在宫颈病变筛查中的应用价值

目的通过对宫颈液基薄层细胞学检查结果的分析,探讨LPT技术在临床诊断上的应用价值。方法统计2006年10月-2007年11月期间本院采用LPT液基薄层细胞试剂盒(美国利普)检查宫颈脱落细胞学的结果,对部分经组织学检查的病例进行对比分析。结果在4200例LPT液基薄层细胞学涂片中阴性病例(NILM包括感染及炎症反应)3 606例。检出阳性病例594例,占总数的14%。其中不典型鳞状细胞(ASC-US)442例,占10.5%,低度鳞状上皮内病变(Lowgrade intraepithe lial lesion,LSIL)133例,占3.16%,不除外高度鳞状上皮内病变(ASC-H)11例,占0.26%。高度鳞状上皮内病变(High grade squamous intraepithelial lesion,HSIL)8例,占0.19%。鳞状细胞癌(SCC)5例,占0.12%,腺癌2例,占0.05%。对148例LPT液基细胞学与组织学检查结果进行对比分析,结果LSIL(36/50)为72%,HSIL:4/4为100%,ASC-H:3/5为60%,ASC-US:22/89为24.7%。结论LPT宫颈液基细胞学试剂制片具有较高的优片率,该技术和TBS诊断系统能准确、迅速、全面地反映宫颈癌和癌前病变。结合病理活检显著提高宫颈癌及癌前病变的诊断准确率。

常规超声、弹性成像技术及细针穿刺在鉴别甲状腺结节中的对比分析

目的比较常规超声、弹性成像技术及细针穿刺在甲状腺结节鉴别诊断中的价值。方法对常规超声检查的96例甲状腺占位性病变的108个结节应用实时组织弹性成像技术进行检查并分级,对所有结节行超声引导下的细针穿刺病理学检查,均与术后病理结果进行对照分析,评估各诊断方法的灵敏度、特异度、阳性预测值、阴性预测值及符合率。结果108个甲状腺结节中,良性病灶66个,恶性病灶42个。弹性成像的灵敏度、特异度、阳性预测值、阴性预测值及符合率分别为88.10%、90.08%、89.14%、90.84%、91.07%;细针穿刺的灵敏度、特异度、阳性预测值、阴性预测值及符合率分别为92.85%、93.71%、91.82%、90.61%、93.89%;超声弹性成像联合细针穿刺的灵敏度、特异度、阳性预测值、阴性预测值及符合率分别为97.86%、87.62%、82.50%、97.72%、94.39%。结论弹性成像和细针穿刺对甲状腺良恶性结节有较高的鉴别诊断价值,两者结合明显提高了该病术前的诊断率。