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.

Promoter Methylation, BRAF Mutation Analysis and Topoisomerase IIa Expression for the Detection of Endometrial Carcinoma in Liquid Based Cytology Samples

Cancer of the corpus uteri remains the most common gynecological related cancer in developed countries. Cytology, after the induction of liquid based cytology, has reemerged as a possible first line non-interventional diagnostic procedure with promising results. Apart from slide preparation for cytology diagnosis, LBC allows the application of elaborate molecular tests on the residual material. Samples from 74 symptomatic women were collected in ThinPrep?PreservCyt medium, from witch immunocytochemical and molecular tests were performed. Final diagnosis of 39 endometrioid carcinomas, 20 non-endometrioid carcinomas and 15 non-malignant was set after hysterectomy. Topoisomerase IIa expression was common (42%) in both types of cancer. Promoter methylation analysis revealed that hMLH1 is commonly methylated in cancers (52.7%), CDKN2A and MGMT less often (27.1%) and RARB rarely methylated (8.4%). BRAF activating mutation V600E was a rare event (8.4%) only found in low grade endometrioid carcinomas. Topoisomerase IIa expression correlated with BRAF mutations, hMLH1 and to lesser extent with CDKN2A methylation. Almost none of the biomarkers were positive in cytological negative or hyperplastic without atypia samples. Detection of methylation in any gene displayed sensitivity, specificity, PPV and NPV similar to cytology of cancer. However, inclusion of cytology diagnosis of hyperlasias with atypia increased sensitivity and NPV of cytology outperforming methylation of any gene. Further evaluation of the panel of promoter methylation, especially in cytology diagnoses of hyperplasia with or without atypia should be evaluated since initial results are promising. Even though methylation of MGMT and RARB are rare events, some patients could be benefit from specific chemotherapeutics that target either of them or the more frequently expressed topoisomerase IIa.

Liquid Based Cytology of Cell Remnants in Needles Used for Breast Fine Needle Aspiration

This study examined cells contained in needles used for the collection of breast fine needle aspirates for the detection of malignant cells trapped in the needles. Remnants of cells contained in 50 needles used for the collection of scanty breast fine needle aspirates were examined by the liquid based cytology technique and compared with the conventional cytological technique of specimens in the corresponding syringes. The breast specimens were collected with clean sterile needles attached to the syringes. Smears were made and stained by the conventional method. The needles were removed from the syringes and a fixative was withdrawn into the syringes and the syringes were recapped with the needles. The fixative containing the specimen was then completely discharged into a centrifuge tube through the needles and treated by the liquid based cytology technique. The study revealed that cells were found trapped in all the needles used for the collection of breast FNA. 6% of them were positive for malignancy, similar to results obtained in the conventional method. Needles used for the collection of breast FNA should be examined before malignancy is completely ruled out particularly in extremely scanty specimens with a clinical suspicion of malignancy.

HPV阳性女性中宫颈液基细胞学、DNA倍体分析及P16/Ki-67双染检测对宫颈癌前病变的分流效果研究

目的探讨在HPV阳性女性中,液基细胞学、DNA倍体分析及P16/Ki-67双染检测对宫颈癌前病变的分流作用。方法回顾性分析2021年5月至2022年12月在我院妇科行阴道镜及宫颈活检的妇女590例。患者高危人乳头瘤病毒(human papilloma virus,HPV)检测阳性,且行液基细胞学(liquid-based cytology,LBC)、DNA倍体分析、P16/Ki-67双染3种检查,对上述3种方法的灵敏度、特异性、受试者工作特征(receiver operating characteristic,ROC)曲线进行统计分析。结果液基细胞学、DNA倍体分析和P16/Ki-67双染3种筛查方法对宫颈癌前病变的灵敏度分别为84.2%、77.5%、76.4%,特异性分别为40.7%、49.2%、70.1%,曲线下面积(area under the curve,AUC)分别是0.625、0.634、0.733,其中,P16/Ki-67双染检测显著优于液基细胞学检查及DNA倍体分析(P<0.0001)。结论本研究认为,在HPV阳性女性中,P16/Ki-67双染检测的分流效果最佳。

HPV检测、液基细胞学及p16/Ki-67三重检测在宫颈高级别病变筛查中的诊断价值研究

目的探讨HPV检测、液基细胞学及p16/Ki-67三重检测在宫颈高级别病变筛查中的诊断价值。方法收集2021-2023年北京天坛医院病理科宫颈活检病例共1839例,回顾性分析HPV检测、液基细胞学(LBC)及p16/Ki-67三重检测的CIN2+检出率,并对比组间的差异,探讨高效而特异的检测方法。结果1839例宫颈活检病例中,CIN2+的总检出率为29.6%;仅HPV阳性、HPV及LBC双检阳性、HPV、LBC及p16/Ki-67三重检测阳性CIN2+检出率依次升高,分别为20.1%、32.3%、54.1%;亚组分析显示HPV16/18阳性,3组的CIN 2+检出率分别是24.4%、45.7%、70.4%;其他12种高危HPV阳性,3组的CIN 2+阳性检出率分别是14.6%、27.4%、45.3%。总体及亚组分析均显示HPV、LBC及p16/Ki-67三重检测的CIN 2+检出率最高,差异具有统计学意义(P<0.001)。结论本研究认为对于HPV阳性的女性,建议进行HPV、LBC及p16/Ki-67三重检测,提高CIN2+阳性检出率,减少漏诊,提升阴道镜的利用效率。

2020-2022年度对泰州市海陵区宫颈癌筛查结果分析

目的:分析2020—2022年度泰州市海陵区的适龄女性宫颈癌筛查结果。方法:选取2020—2022年度泰州市海陵区的47445名女性作为研究对象,实施宫颈癌筛查工作,对筛查结果异常者进行随访、复诊,追踪最终组织病理检查结果。结果:2020—2022年度泰州市海陵区人乳头瘤病毒(HPV)总阳性率为11.19%,HPV阳性合并阴道炎占HPV阳性的37.11%。液基薄层细胞学检测(TCT)总参与率为95.79%,2020、2021、2022年分别为94.59%、95.02%、97.54%,参与率逐年提高。TCT检查总异常率为26.34%,异常分型总例数前3位由高到低依次为意义不明确的非典型鳞状细胞、低度鳞状上皮内病变、不除外高度鳞状上皮内病变。阴道镜检查总参与率为95.20%,2020、2021、2022年分别为90.94%、96.01%、97.96%,参与率逐年升高。阴道镜检查总异常或可疑率为88.69%,2020—2022年阴道镜检查异常或可疑率逐年提高。阴道镜总活检阳性率为54.66%。结论:宫颈癌的筛查可提高二级预防水平,泰州市海陵区应关注下生殖道感染筛查管理,加强筛查工作的精细化管理及阴道镜评估水平。

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.

HPV-23分型、TCT联合P16表达检测在宫颈病变筛查中的应用

目的探讨分析HPV-23分型、TCT联合P16表达检测在宫颈病变筛查中的应用。方法选取2022年6月—2023年6月在本院参加宫颈癌筛查的妇女200例为研究对象,进行HPV-23分型、TCT、P16表达检测,以病理学结果为金标准,计算HPV-23分型、TCT、P16单项检测和联合检测的诊断灵敏度、特异度。结果HPV-23分型检测结果显示阳性病例33例,阴性病例62例;TCT检测结果显示阳性病例35例,阴性病例72例;P16检测结果显示阳性病例19例,阴性病例115例;联合检测结果显示阳性病例48例,阴性病例139例。在诊断效能方面,HPV-23分型、TCT、P16单项检测以及联合检测的诊断灵敏度分别为62.26%、66.04%、35.85%及83.02%,而特异度则分别为42.18%、48.98%、78.23%及89.80%。经过对比分析,联合检测在灵敏度和特异度方面均表现出最高的效能(P<0.05)。结论HPV-23分型、TCT联合P16表达检测用于宫颈病变筛查中的价值较高,可作为首选筛查手段。

P16/Ki-67双染、TCT细胞学、HPV联合检测技术在宫颈病变筛查中的应用价值分析

目的探讨与分析P16/Ki-67双染、液基薄层细胞学检查(Thinprep Cytologic Test,TCT)、人乳头状瘤病毒(Human Papilloma Virus,HPV)联合检测技术在宫颈病变筛查中的应用价值。方法收集2022年4月—2023年4月选择在酒钢医院自愿行宫颈病变筛查且后期进行宫颈组织活检的83例就诊人群为研究对象,所有人群都给予P16/Ki-67双染、TCT细胞学、HPV联合检测,分别记录检测阳性情况。同时所有人群都进行了病理组织检查,并以此为诊断金标准,判断诊断价值。结果在83例患者中,病理检查为正常组织21例、CIN 1级47例、CIN 2级12例、CIN 3级3例,其中高级别上皮内瘤变占18.07%。83例患者中,正常组织、CIN 1级、CIN 2级、CIN 3级患者的P16/Ki-67双染、TCT细胞学、HPV联合检测阳性率分别为4.76%、10.64%、66.67%、66.67%。P16/Ki-67双染、TCT细胞学、HPV检查单独检测与联合检测对宫颈病变的诊断敏感性分别为66.67%(10/15)、66.67%(10/15)、100.00%(15/15)、66.67%(10/15),诊断特异性分别为91.18%(62/68)、60.29%(41/68)、17.65%(12/68)、91.18%(62/68)。结论P16/Ki-67双染、TCT细胞学、HPV联合检测技术能更准确地发现潜在的高级别病变患者,提高宫颈病变检出率,有很好的应用价值。

全自动免疫细胞化学染色P16/Ki-67双染在宫颈病变筛查的价值

目的探讨与分析全自动免疫细胞化学染色P16/Ki-67双染在宫颈病变筛查的价值。方法选取2022年4月—2023年6月在酒钢医院进行宫颈病变筛查的120例患者作为研究对象,所有患者都给予液基薄层细胞学(thinprep cytologic test,TCT)检查、病理检查、HPV检测与全自动免疫细胞化学染色P16/Ki-67双染检查,判定筛查结果。结果在120例患者中,P16/Ki-67双染阳性28例,总阳性率为23.3%。液基薄层细胞学检查判断为良性反应性细胞改变67例、宫颈未明确诊断意义的非典型鳞状上皮细胞37例、低级别宫颈鳞状上皮内病变12例、高级别宫颈鳞状上皮内病变4例,其P16/Ki-67双染阳性率分别为16.4%、21.6%、41.6%、100.0%。在120例患者中,病理检查判断:正常16例,宫颈上皮内瘤变Ⅰ级85例、宫颈上皮内瘤变Ⅱ级14例、宫颈上皮内瘤变Ⅲ级4例、宫颈癌1例,其P16/Ki-67双染阳性率分别为6.2%(1例)、15.3%(13例)、71.4%(10例)、75.0%(3例)、100.0%(1例),差异有统计学意义(P<0.05)。以病理检查结果作为金标准,全自动免疫细胞化学染色P16/Ki-67双染在宫颈病变中的敏感性与特异性分别为73.7%(14/19)、86.1%(87/101)。ROC曲线分析显示全自动免疫细胞化学染色P16/Ki-67双染在宫颈病变筛查的曲线下面积为0.872,Kappa值为0.824。结论全自动免疫细胞化学染色P16/Ki-67双染在宫颈病变筛查诊断宫颈癌的敏感性与特异性都比较高,具有很好的临床应用价值。

TCT和HPV-DNA在绝经女性宫颈癌筛查中的应用价值

目的 探讨薄层液基细胞学(TCT)检测和人乳头瘤病毒(HPV-DNA)分型检测对于绝经女性宫颈癌前病变筛查中的应用价值,为体检中心开展筛查、随访及健康教育工作提供依据。方法 以2018年8~10月体检中心参加宫颈癌筛查、年龄≤65岁的绝经女性200例作为研究对象,研究对象均参加TCT检测和HPV-DNA分型检测,排除TCT和HPV双阴性的绝经女性,对有任一阳性的绝经女性均进行阴道镜下病理活检,比较TCT和HPV的阳性检出率及灵敏度;TCT阴性组和TCT阳性组的病理学阳性检出率及HPV的阳性检出率;进一步分析HPV-DNA不同分型病理学阳性检出率及TCT阳性组和HPV-DNA阳性组、联合阳性组的病理学阳性检出率。结果 TCT和HPV双阴性的检出人数82例,TCT和HPV任一阳性检出人数118例,其中,TCT阳性的68例;HPV阳性的98例,双阳性48例,病理学阳性人数65例。TCT阳性检出率低于HPV,差异有统计学意义(P<0.01);65例病理学阳性患者中,TCT和HPV阳性人数为41例、58例,灵敏度为63.1%、89.2%,差异有统计学意义(P<0.01);TCT阴性组中检出病理学阳性人数24例、HPV阳性人数50例,TCT阳性组检出病理学阳性人数41例、HPV阳性人数48例,2组病理学阳性检出率(48%、60.3%)比较差异无统计学意义(P>0.05),HPV的阳性检出率(100%、70.6%)比较差异有统计学意义(P<0.01);HPV-DNA分型检测结果中,HPV-DNA分型为16、18单一或混合阳性43例,病理学阳性人数31例;其他型阳性55例,病理学阳性人数27例,二者的病理学阳性检出率(72.1%、49.1%)比较差异有统计学意义(P<0.05);TCT阳性组和HPV阳性组及联合阳性组的病理学阳性检出率比较差异有统计学意义(P<0.05)。结论 HPV-DNA分型检测对绝经女性宫颈癌筛查灵敏度高,单用TCT筛查会造成漏诊,联合筛查有助于提升健康体检绝经女性的早期筛查效率,对体检中心开展筛查管理具有重要意义。

P16蛋白检测联合HR-HPV、TCT在宫颈癌前病变及宫颈癌诊断中的价值

目的:探讨P16蛋白检测联合高危型人乳头瘤病毒(high-risk human papilloma virus,HR-HPV)、液基薄层细胞学检测(thinprep cytologic test,TCT)在宫颈癌前病变及宫颈癌诊断中的临床价值。方法:选取2019年9月至2021年8月在承德市中心医院妇科门诊行宫颈癌筛查的390例患者为研究对象。所有患者均行P16蛋白、HRHPV及TCT检测。任一结果阳性者或高度怀疑宫颈恶性病变者行阴道镜下宫颈活检组织病理检查。探讨P16蛋白、HR-HPV、TCT检测及两两联合检测在宫颈癌中的诊断,并绘制诊断的受试者工作特征(receiver operating characteristic,ROC)曲线。结果:390例患者中,HR-HPV阳性者101例,阳性率25.90%(101/390);TCT阳性者64例,阳性率16.41%(64/390);P16阳性者57例,阳性率14.62%(57/390)。任一阳性者133例,共召回100例行阴道镜活检,组织病理学结果为:正常或炎症62例,宫颈低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)19例,高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)14例,宫颈癌5例;组织病理学检测阳性19例,阴性81例。在组织病理学检测阳性中,HR-HPV阳性18例,TCT检测阳性14例,P16阳性者17例。HR-HPV、TCT及P16诊断HSIL及宫颈癌的敏感度分别为94.74%、73.68%、89.47%,差异无统计学意义(P>0.05);P16诊断HSIL及宫颈癌的特异度高于TCT与HR-HPV检测,差异有统计学意义(P<0.05)。在两两联合检测中,HR-HPV+P16诊断HSIL及宫颈癌的敏感度最高,但3种联合检测方式的敏感度比较无统计学意义(P>0.05);TCT+P16诊断HSIL及宫颈癌的特异度为86.39%,高于HR-HPV+TCT、HR-HPV+P16(P<0.05)检测。HR-HPV、TCT、P16、HR-HPV+TCT、TCT+P16及HR-HPV+P16诊断宫颈癌前病变及宫颈癌的AUC分别为0.880、0.814、0.915、0.858、0.879、0.902。结论:P16的表达与宫颈病变进展具有正相关性,其可提高HSIL及宫颈癌的诊断效能,降低误诊率。P16+TCT检测相较于HR-HPV+TCT在不损失敏感度的前提下,有更高的特异度。

p16/Ki-67双染对比液基细胞学及HPV DNA检测在宫颈癌早期筛查中的价值

目的:液基细胞学(liquid-based cytology,LBC)及高危型人乳头瘤病毒(human papilloma virus,HPV)DNA检测在宫颈早期病变筛查中具有重要意义,但在临床检测过程中也凸显出一些不足。p16/Ki-67双染是一种新兴的检测方法。本研究探讨p16/Ki-67双染检测对比LBC及HPV DNA检测在宫颈早期病变筛查中的特点。方法:选取2021年7月至2023年7月郑州市妇幼保健院妇科收治的组织学证实为慢性宫颈炎、低度鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)、高度鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)及以上且均进行LBC、HPV DNA、p16/Ki-67双染检测的292例患者作为研究对象。所有患者以组织病理学诊断为金标准,分析p16/Ki-67双染检测在不同活体组织检查(以下简称“活检”)分级中的差异和在LBC异常结果以及HPV DNA检测阳性和LBC阴性样本中的分流作用,分析LBC、HPV DNA、p16/Ki-67双染检测在宫颈病变中的诊断效能并进行受试者操作特征(receiver operator characteristic,ROC)曲线的效果评价。结果:LBC检出的无上皮内病变或恶性病变(negative for intraepithelial lesion or malignancy,NILM)与活检结果符合率为67.6%(119/176),意义不明确的非典型鳞状细胞(atypical squamous cells of undetermined significance,ASC-US)中有26.7%(20/75)患者活检阴性,LSIL及以上病变中有22.0%(9/41)患者活检阴性。HPV DNA检测阳性(包括单独HPV DNA检测阳性及合并LBC、p16/Ki-67双染阳性)患者中60.5%(135/223)活检为LSIL和HSIL,39.5%(88/223)活检为阴性。p16/Ki-67双染阳性患者中,70.4%(112/159)活检为LSIL和HSIL,29.6%(47/159)活检为阴性。3种检测方法中,p16/Ki-67双染与活检符合率最高,为72.9%(213/292)。对于LSIL及以上病变,HPV DNA检测灵敏度最高,为93.8%;LBC特异度最高,为80.4%,而3种方法两两联合筛查之间结果差异无统计学意义(均P>0.05)。p16/Ki-67双染对HPV DNA检测阳性标本比LBC更具有指导意义;p16/Ki-67双染在LBC真阴性标本中比HPV DNA检测更具优势;而对于HPV DNA检测阳性而LBC检测阴性的标本,p16/Ki-67双染差异也有统计学意义(P<0.05)。结论:p16/Ki-67阳性率与宫颈病变严重程度相关;p16/Ki-67联合LBC或HPV DNA检测可有效提高LBC和HPV结果不一致时的准确性。

TCT与阴道镜在HR-HPV阳性女性子宫颈高级别及以上鳞状上皮内病变诊断中的应用价值

目的探讨宫颈液基细胞学(thinprep cytologic test,TCT)与阴道镜检查在高危型HPV阳性(high⁃risk human papillomavirus,HR⁃HPV)女性人群中诊断宫颈高级别及以上病变(high grade squamous intraepithelia lesion and above,HSIL+)的临床应用价值。方法收集克拉玛依市中心医院2018年1月至2021年11月的宫颈HR⁃HPV阳性病例2445例,回顾性分析TCT诊断、阴道镜诊断与组织病理学诊断的相符情况,比较TCT、阴道镜及阴道镜结合TCT诊断HSIL+的情况。结果TCT诊断与组织学诊断符合率为84.25%,一致性检验Kappa值为0.565。阴道镜诊断与组织学诊断符合率为88.30%,一致性检验Kappa值为0.69。TCT诊断HSIL+的灵敏度是60.69%,特异度是92.53%;阴道镜诊断HSIL+的灵敏度是74.52%,特异度是93.15%;阴道镜结合TCT结果诊断HSIL+的灵敏度是79.09%,特异度是86.07%。细胞学诊断HSIL+的受试者工作特征曲线下面积(Area Under Curve,AUC)为0.766,阴道镜诊断HSIL+的AUC为0.838,阴道镜结合TCT诊断HSIL+的AUC为0.826。结论在宫颈HR⁃HPV阳性女性中,阴道镜诊断宫颈HSIL+的临床价值较高,阴道镜结合TCT可以提高诊断HSIL+的灵敏度,减少HSIL+的漏诊率。

P16/Ki-67双染在宫颈癌筛查中的应用价值分析

目的探讨抑制基因蛋白16(P16)/原癌基因细胞增殖核抗原(Ki-67)双染在宫颈癌筛查中的应用价值。方法回顾性分析2020年10月至2022年5月就诊于郑州市妇幼保健院的100例宫颈病变患者的临床资料,患者年龄(55.65±2.14)岁,均接受P16/Ki-67双染检测、液基细胞学(TCT)检查、高危人乳头瘤病毒(HR-HPV)检测,以阴道镜下活检结果为金标准,计量资料采用t检验,计数资料采用χ^(2)检验,利用受试者工作特征曲线(ROC),分析HR-HPV、TCT、P16/Ki-67双染诊断宫颈病变价值。结果100例宫颈病变患者,经阴道镜活检发现14例(14.00%)为炎症病变,宫颈上皮内瘤变(CIN)Ⅰ26例(26.00%),CINⅡ26例(26.00%),CINⅢ28例(28.00%),宫颈鳞状细胞癌(SCC)6例(6.00%)。HR-HPV对宫颈病变诊断的灵敏度为97.67%(84/86)、特异度为85.71%(12/14)、准确度为96.00%(96/100),TCT对宫颈病变诊断的灵敏度为88.37%(76/86)、特异度为78.57%(11/14)、准确度为87.00%(87/100),P16/Ki-67双染对宫颈病变诊断的灵敏度为91.86%(79/86)、特异度为85.71%(12/14)、准确度为91.00%(91/100);HR-HPV、TCT、P16/Ki-67双染相比,差异均无统计学意义(均P>0.05)。HR-HPV、TCT、P16/Ki-67双染诊断宫颈病变的曲线下面积(AUC)分别为0.917、0.835、0.888,P16/Ki-67双染检测分别与TCT、HR-HPV检查相比,AUC的差异均无统计学意义(均P>0.05)。结论P16/Ki-67双染筛查宫颈癌及癌前病变效果与TCT、HR-HPV相似,其具有高效、客观、简便、易重复等优点,可作为宫颈癌及癌前病变初筛的新选择。

甲状腺细针穿刺液基细胞学Ⅲ类患者CK19、Galectin-3、HBME-1、TPO抗体检测及其临床意义

目的检测甲状腺细针穿刺液基细胞学Ⅲ类患者细胞角蛋白19(CK19)、半乳糖凝素-3(Galectin-3)、间皮细胞(HBME-1)、甲状腺过氧化物酶(TPO)抗体水平,并探讨其临床意义。方法回顾性分析2019年1月至2020年12月西安宝石花长庆医院收治的100例甲状腺细针穿刺液基细胞学Ⅲ类患者的临床资料,所有患者均经手术取得病理诊断结果,依据病理诊断结果分为良性组65例和甲状腺乳头状癌组35例。检测并比较两组患者CK19、Galectin-3、HBME-1、TPO阳性率,同时比较其诊断甲状腺乳头状癌的准确性、敏感性、特异性、阴性预测值及阳性预测值。结果甲状腺乳头状癌组患者的CK19、Galectin-3、HBME-1阳性率分别为97.14%、91.43%、85.71%,明显高于良性组的6.15%、3.08%、7.69%,TPO阳性率为5.71%,明显低于良性组的93.85%,差异均有统计学意义(P<0.05);CK19、Galectin-3、HBME-1、TPO及四者联合诊断甲状腺乳头状癌的准确性、敏感性、特异性、阴性预测值和阳性预测值比较差异均无统计学意义(P>0.05)。结论甲状腺细针穿刺液基细胞学Ⅲ类患者CK19、Galectin-3、HBME-1、TPO抗体检测可显著提升细胞学诊断效能,有较大的应用价值。

p16/Ki-67双染、液基细胞学检测系统检测对宫颈疾病的诊断价值

目的:探讨p16/Ki-67双染、液基细胞学检测系统(LCT)检测对宫颈疾病的诊断价值。方法:选取2022年7月—2023年3月到上海市嘉定区安亭医院就诊的50例疑似患有宫颈疾病的患者作为研究对象,全部患者均行p16/Ki-67双染、LCT检测及阴道镜宫颈活检,并以阴道镜宫颈活检为金标准。记录p16/Ki-67双染、LCT及阴道镜宫颈活检检测结果,采用Kappa法进行一致性分析,计算灵敏度、特异度及准确度。结果:共46例患者患有宫颈疾病,阳性率为92.00%。p16/Ki-67双染、LCT检测结果与阴道镜宫颈活检结果相比,两者一致性较好(Kappa≥0.75,P<0.05),p16/Ki-67双染与LCT检测结果相比,两者一致性较好(Kappa≥0.75,P<0.05)。p16/Ki-67双染检测与LCT检测准确度相比,差异无统计学意义(P>0.05)。在疾病类型方面,p16/Ki-67双染检测总检出率高于LCT检测,差异有统计学意义(P<0.05)。结论:p16/Ki-67双染、LCT检测结果与阴道镜宫颈活检结果符合程度均较高,但p16/Ki-67双染检测对疾病类型总检出率更高,具备较高的临床应用价值。

HR-HPV阴性的ASC-US患者发生宫颈上皮内病变的影响因素分析

目的 分析高危型人乳头状病毒(high risk human papillomavirus, HR-HPV)阴性的无明确意义的非典型鳞状上皮细胞(atypical squamous cell of undetermined significance, ASC-US)患者发生宫颈上皮内病变的影响因素。方法 选取2021年3月—2023年3月期间东莞市南城医院收治的发生宫颈上皮内病变的60例患者为研究对象(其宫颈液基细胞学检查均为ASC-US、HR-HPV阴性),给予宫颈活检术检查,分析其临床资料。结果 宫颈活检结果显示,高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion, HSIL)及以上患者为7例,低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion, LSIL)及以下患者为53例。单因素分析结果显示,是否绝经在HSIL及以上患者和LSIL及以下患者之间,差异有统计学意义(P<0.05);多因素分析结果显示,绝经是HR-HPV阴性的ASC-US患者发生HSIL及以上病变的保护因素,阴道镜评估结果是HR-HPV阴性的ASC-US患者发生HSIL及以上病变的危险因素(OR=0.105、2.248,P<0.05)。结论 HR-HPV阴性的ASC-US患者中阴道镜评估结果显示HSIL及以上的患者发生HSIL及以上病变风险增加,需要加大患者的关注度,及时开展评估和治疗。

HR-HPV+TCT联合检测在宫颈癌筛查中的应用效果分析

目的探讨高危型人乳头瘤病毒(HR-HPV)+液基薄层细胞学(TCT)联合检测在宫颈癌筛查中的应用效果。方法选取本院1307例宫颈癌筛查患者为研究对象,均行HR-HPV检测和TCT检测,以病理检查结果为金标准,分析单独检测与联合检测的诊断效能。结果联合检测的敏感度、特异度、准确度、阳性预测值、阴性预测值均优于HR-HPV和TCT(P<0.05);Kappa检验显示,HR-HPV、TCT与病理检查的一致性尚可,联合检测与病理检查的一致性较好。结论HR-HPV+TCT联合检测在宫颈癌筛查中的应用效果显著,能提高对宫颈癌的诊断效能,指导临床早期诊治。