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.

LCT联合阴道镜检查对宫颈病变筛查的临床分析

目的：评价液基细胞学检查（1iquid-based cytologic test，LCT）配合阴道镜检查对子宫颈病变的诊断价值。方法：收集2006年1月-2007年8月在我院妇科门诊就诊患者，采用LCT检测，对细胞学检查异常的1116例进行阴道镜检查及活检。结果：LCT异常者占10．15％，LCT和阴道镜对低度鳞状上皮内瘤变（LSIL）的检出率分别为65．45％和71．01％，高度鳞状上皮内瘤变（HSIL）为70．54％和84．50％，宫颈浸润癌（CC）为89．55％和92．53％。结论：细胞学筛查是诊断宫颈病变的重要方法，配合阴道镜下活检，能提高子宫颈癌前病变和宫颈早期浸润癌检出率，具有重要的临床意义。

LCT+HPV联合筛查体检人群在宫颈病变诊断中的作用

目的探讨LCT+HPV联合筛查体检人群在宫颈病变诊断中的作用。方法对2005年4月-2006年10月期间在我院体检中心同时进行LCT+HPV联合筛查宫颈癌的正常人群进行普查,对其中任一项阳性的225例体检人群进行光电一体阴道镜检查并以组织学诊断为金标准进行分析,探讨深圳市体检人群HPV感染情况与宫颈病变的发病情况。结果我院体检人群HPV感染率15.81%,不同年龄段HPV感染率、宫颈高度病变的发生率不同和(或)不全相同,p>0.05,统计学差异无显著性;LCT异常诊断率13.74%,LCT诊断级别升高,HPV感染率、宫颈高度病变发生率显著增高,p<0.05,差异显著,有统计学意义;LCT(LCT≥LSIL)、HPV、LCT+HPV(LCT≥LSIL)筛查宫颈高度病变的灵敏度、特异度、阴性预测值、阳性预测值分别为67.44%、97.67%、82.56%;67.21%、14.84%、41.21%;89.78%、96.43%、90.91%;32.95%、21.32%、24.91%。结论宫颈高度病变的发生集中在生育及性活跃期,也趋于年轻化,处于此年龄段的妇女应重视体检筛查。HPV感染与低度病变高危人群,建议定期跟踪随访,防止宫颈癌的发生;LCT+HPV联合筛查进行宫颈癌普查工作,可大大提高从正常人群体查中宫颈高度病变的诊断率,降低漏诊率,二者结合将更有利于宫颈病变的分流管理。

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.

宫颈细胞学传统涂片与LCT液基细胞涂片的有关讨论

目的宫颈细胞应用传统涂片巴氏法及LCT液基涂片染色后,镜下观察细胞学形态变化及细胞类型的出现等评价。方法为取得足够诊断的细胞数量定点取材,做巴氏涂片或LCT液基涂片,镜下观察结果。结果传统涂片巴氏染色片在最低8000～12000个[1]形态完好的鳞状细胞范围之上时,LCT涂片在最低5000个之上细胞范围时,病变的阳性细胞检出率高,细胞数量在40000～80000个时,对于诊断的质量绝大部分无疑义。结论传统巴氏涂片中细胞成分常多于LCT涂片,但细胞较集中不像LCT涂片那样散在和混存,易于诊断,常能进一步提示异常细胞在涂片能进一步表达。

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.

宫颈LCT结合阴道镜及宫颈活检对宫颈上皮内瘤变和宫颈癌患者的早期诊断价值研究

目的探讨宫颈液基细胞学检查(liquid-based cytological test,LCT)结合阴道镜及宫颈活检对宫颈上皮内瘤变和宫颈癌患者的早期诊断价值。方法回顾性分析250例宫颈LCT阳性的病例,对其进行宫颈活检。比较细胞学与组织学结果,并研究发病率与年龄的关系。结果在所有LCT阳性病例中,ASC-US 142例(在阳性病例中占56.8%),AGC为3例(1.2%),ASC-H 24例(9.6%),LSIL 82例(54.4%),HSIL为26例(10.4%),SCC 1例(0.4%);宫颈活检结果中,炎性反应66例(26.4%),挖空细胞25例(10.0%),CINⅠ级54例(21.6%),CINⅡ级59例(23.6%),CINⅢ级28例(11.2%),鳞癌16例(6.4%),腺癌2例(0.8%),以组织学结果验证细胞学结果,符合率分别为ASC-US(100.0%),ASC-H(92.3%),LSIL(63.2%),HSIL(72.9%),SCC(100.0%);并且宫颈病变多见于30~50岁年龄段。结论宫颈LCT具有较高的准确性,是筛查宫颈上皮性病变的重要手段,结合阴道镜及宫颈活检可使宫颈上皮内瘤变和宫颈癌患者得到早期诊断和早期治疗。

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.

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。

未明确诊断意义的不典型鳞状上皮细胞临床处理方法的探讨

目的:探讨宫颈液基细胞学检查(LCT)结果为未明确诊断意义的不典型鳞状上皮细胞(ASCUS)的临床处理方法。方法:LCT检查结果为ASCUS的患者454例,将其随机分为3组:A组,151例,3月后复查LCT;B组,152例,随即进行高危型人乳头瘤病毒(HPV)检测;C组,151例,随即进行阴道镜检查,并在阴道镜下活检。比较3组ASCUS患者宫颈上皮内瘤变(CIN)的检出情况。结果:①A组复查LCT,细胞学异常(≥ASCUS)39例(25.83%),阴道镜下活检病理结果为宫颈炎24例,CINⅠ5例,CINⅡ9例,CINⅢ1例。95例复查LCT正常者阴道镜下活检,病理结果为宫颈炎88例,CINⅠ4例,CINⅡ2例,CINⅢ1例。②B组有60例(39.47%)高危型HPV检测阳性,其阴道镜下活检病理结果为宫颈炎32例,CINⅡ13例,CINⅡ13例,CINⅢ2例。80例HPV阴性者阴道镜下活检,病理均为宫颈炎。③C组151例ASCUS直接进行阴道镜检查及阴道镜下活检,病理结果为宫颈炎115例,CINⅠ12例,CINⅡ18例,CINⅢ6例。④复查LCT和检测高危型HPV对预测ASCUS患者中宫颈高级别病变的准确性差异无统计学意义(P>0.05)。结论:复查LCT是有效的分流ASCUS的方法。对于依从性差或高危人群,宜作高危型HPV检测进行分流,或直接行阴道镜检查及镜下活检明确诊断,随即作相应处理。

宫颈上皮内病变与HPV相关

目的了解辽宁省妇女生殖道人乳头瘤病毒(Human Papillomavirus,HPV)感染情况,研究辽宁省妇女宫颈上皮内病变与HPV感染的相关性。方法回顾性分析600例行核酸分子快速导流杂交基因芯片技术(Hybri Max)检测的患者,该600例患者均行薄层液基细胞学技术(Liguid-based cytologic teset,LCT)检查,有127例患者行病理活检,结合3种方法研究HPV感染与宫颈病变的相关性。结果导流杂交HPV-DNA检测结果与LCT结果相结合,600例患者中,感染HPV的阳性率分别为正常32%(92/288),Asc-us42%(87/208),LSIL53%(40/75),HSIL86%(19/22),癌100%(7/7)。导流杂交HPV-DNA检测结果与病理活检结果相结合,感染HPV的阳性率分别为:正常或慢性炎症36.17%(17/47),CINⅠ66.67%(36/54),CINⅡ-Ⅲ84.21%(16/19),癌100%(7/7),HPV感染阳性率随宫颈病变程度加重而明显升高。细胞学与组织学病理诊断符合率分别为LSIL72%(54/75),HSIL86.36%(19/22),SCC100%(7/7)。不同年龄阶段妇女感染HPV的阳性率依次为20-29岁46.76%(65/139),30-39岁43.41%(79/182),40-9岁40.48%(71/174),50-59岁38.16%(29/76),60-69岁37.50%(6/16),70岁76.92%(10/13)。600例患者HPV感染总阳性率为40.83%(245/600),在HPV21种亚型中,有19种亚型均被检测出,感染率最高的是HPV16 35.51%(87/245),其它常见型别依次为HPV58,HPV6,HPV53,HPV18,HPV31,HPV52和cp8304。此外还发现高危型HPV16的感染率:正常或慢性炎症35.29%(6/17)CINⅠ33.33%(12/36),CINⅡ-Ⅲ56.25%(9/16),癌85.71%(6/7),其感染率阳性率在各种程度的宫颈病变中占很大比重,也随宫颈病变的严重程度而增高,进一步论证了HPV16的高危性。结论辽宁省妇女HPV感染的主要亚型是HPV16,HPV58及HPV6.无论是与细胞学检测结果相结合还是与病理活检结果相结合,HPV感染阳性率均随宫颈病变程度的加重而增高。提示宫颈病变的防治重点应放在预防及治疗HPV感染。

液基细胞学联合免疫细胞化学对疑难肺腺癌转移胸腔积液的诊断价值

目的:探讨利用BD TriPath液基细胞学联合免疫细胞化学对疑难肺腺癌转移胸腔积液的诊断价值。方法:对临床初次送检的31例胸腔积液标本,采用BD TriPath液基细胞制片染色仪,每例制片5张,1张巴氏染色用于细胞学诊断,其余4张行免疫细胞化学染色分别检测癌胚抗原(carcinoembr yonic antigen,CEA)、甲状腺转录因子1(thyroid transcription factor 1,TTF-1)、间皮细胞抗原(mesothelial cell,MC)、钙结合蛋白(calretinin,CR)的表达。结果:呼吸科门诊或住院患者送检的31例胸腔积液,经证实肺腺癌转移的胸腔积液24例,7例未见恶性肿瘤细胞。31例胸腔积液经免疫细胞化学染色显示,CEA、TTF-1鉴别腺癌细胞的灵敏度分别为79.2%,66.7%,特异度为96.8%,100%;MC,CR鉴别间皮细胞的灵敏度分别为93.5%,100%,特异度为95.8%,83.3%。两组抗体在腺癌细胞及间皮细胞者的表达差异有显著统计学意义(P<0.01)。单独BD TriPath液基细胞学可明确诊断肺腺癌转移15例、未见恶性肿瘤细胞6例,10例未能明确诊断。如果结合免疫细胞化学可明确诊断肺腺癌转移21例、未见恶性肿瘤细胞6例,仅4例不能明确诊断,两者相结合使阳性检出率显著提高(P<0.05)。结论:基于BD TriPath液基细胞薄片上的免疫细胞化学有助于提高对胸腔积液中转移性肺腺癌细胞的诊断。CEA,TTF-1,MC,CR联合应用可有效辅助细胞学鉴别肺腺癌细胞及间皮细胞,值得推广应用。

腹腔镜辅助阴式子宫切除35例I临床分析

目的探讨腹腔镜辅助阴式子宫切除术的临床应用价值。方法通过对非脱垂子宫经阴道全子宫切除术与腹腔镜辅助阴式子宫切除术的临床资料进行回顾性分析，比较两组的手术时间、术中出血量、术后下床活动时间、术后排气时间、住院时间等是否存在差异。结果两组的术中出血量、术后排气时间和住院时间比较差异无统计学意义（均P〉0．05）；腹腔镜辅助阴式子宫切除术组的手术时间、术后下床活动时间均明显低于经阴道全子宫切除术组，差异有统计学意义（t值分别为4．014、5．790，均P〈0．05）。结论腹腔镜辅助阴式子宫切除术具有微创、切口小、损伤小、并发症少、恢复快等优点，在临床上具有更大的发展空间。

HPV阳性患者基因分型及病毒负载量分析

目的研究广州地区宫颈人乳头状瘤病毒(HPV)的感染状况及基因型分布,并探讨病毒负载量与宫颈鳞状上皮内病变的关系。方法收集中山大学肿瘤防治中心2013年7月至2015年10月收治的1 105名女性的宫颈刷取物标本,采用表面等离子体谐振技术(SPR)检测HPV型别及负载量,同时行宫颈液基细胞学检查(LCT)。细胞学检查阳性患者加做阴道镜及病理活检。结果共检测出HPV阳性标本210例,感染率为19.00%。共检出23个基因型,包括16个高危型(HR-HPV)和7个低危型(LR-HPV)。单一高危型169例(15.29%),平均负载量为(170.59±85.91)m°;单一低危型20例(1.81%),平均负载量为(111.75±37.39)m°;HPV多重感染21例(1.90%)。单一HR-HPV阳性患者的平均病毒负载量显著高于阴性患者,差异有统计学意义(Z=-3.256,P=0.001)。结论 SPR和LCT联合检测有助于宫颈癌前病变的诊断,对进一步临床治疗有指导意义。

液基细胞学技术对减少临床医疗纠纷的应用价值

目的探讨液基细胞学技术对于减少临床医疗纠纷的价值。方法对1531例样本分别用液基细胞学方法和传统巴氏涂片技术进行宫颈细胞学涂片制作,其中液基细胞学方法分别用新柏氏耗材和昂佰氏耗材;涂片根据TBS 2001标准进行诊断;细胞学诊断为LSIL以上病变(包括LSIL、HSIL、SCC和AC)者组织活检进行组织学诊断;应用SPSS11.0软件进行数据分析。结果液基细胞学方法同传统巴氏方法相比,在标本满意度、敏感度、特异度和准确性、假阴性率和误诊率等方面有显著统计学差异(P<0.05),新柏氏和昂佰氏获得结果之间无明显差异。结论液基细胞学技术可以有效提高宫颈癌普查的诊断水平,从而有效防止和减少医疗纠纷的发生;昂佰氏耗材可以替代新柏氏耗材进行液基细胞学检查。

HPV的定量和分型检测在ASCUS分流诊断中的作用比较

目的探讨高危型人乳头瘤病毒(HR-HPV)的定量和分型检测在意义不明的非典型鳞状细胞(ASCUS)分流诊断中的作用比较。方法回顾性分析2015年1月至2017年12月在上海交通大学医学院附属国际和平妇幼保健院宫颈疾病诊疗中心就诊的经液基细胞学(LCT)检测为ASCUS并接受阴道镜检查的3 607例患者为研究对象。所有受试者在LCT检查同时行HR-HPV的定量或分型检测,在LCT检查后两个月内进行阴道镜检查并做组织病理学活检。采集所有受试者信息包括年龄、绝经状态、HR-HPV检测结果、孕次、产次和病理检查结果并进行统计学分析。根据病理检查结果将受试者分为两组:正常/CIN1和CIN2及以上病变/宫颈癌。比较两组患者的年龄、绝经状态、HR-HPV感染、孕产次等的分布情况。分析与ASCUS分流诊断的相关因素。结果纳入本研究的3 607例ASCUS患者通过病理检查结果显示:79.60%(2 871/3 607)病例未发现病变;20.27%(731例)为CIN,其中16.14%(582例)为CIN 1和4.13%(149例)为CIN2及以上病变。0.14%(5例)病例被确诊为宫颈癌。单因素分析显示年龄(t=2.47,P=0.01)、绝经(χ^2=5.85,P=0.02)和HR-HPV感染(χ^2=41.21,P<0.01)与CIN2及以上病变或宫颈癌相关。将HR-HPV分成定量检测和分型检测进行比较,结果显示HR-HPV定量检测在两组间的比较,差异无统计学意义(t=0.88,P=0.38)。HR-HPV分型检测显示HPV-16型感染(χ^2=133.24,P<0.01)和HPV-18型感染(χ^2=7.60,P=0.01)与CIN2及以上病变或宫颈癌相关。多因素分析显示,通过分型检测的HPV-16感染(95%CI:4.88~14.04,P<0.01)或HPV-18感染(95%CI:1.06~5.28,P=0.04)是CIN2及以上病变或宫颈癌的独立危险因素。结论 HR-HPV分型检测可以提高ASCUS分流诊断的准确性,有助于建立ASCUS的有效分流管理策略。