摘要
【目的】探讨宫颈液基细胞学检查（TCT）对宫颈病变的诊断价值及意义。【方法】回顾性分析中国医科大学附属盛京医院门诊57784例TCT筛查结果。细胞学诊断采用TBS（2001）分级报告系统，阳性诊断包括意义不明确的不典型鳞状细胞（ASC—US）及以上病变，其中阳性者554例行阴道镜下宫颈活组织检查，其中317例同时又进行了宫颈高危型人乳头瘤病毒DNA（HPV-DNA）检测，对三者进行了对比分析。另外对经宫颈活检证实为宫颈癌并同时有TCT检测结果的103例患者结果也进行了对比分析。【结果】①TCT检查阳性结果与宫颈活检诊断符合率：鳞状细胞癌（SCC）3例及腺癌4例均符合组织病理学诊断；高级别鳞状上皮内病变（HSIL）符合率为86．67％（91／105），低级别鳞状上皮内瘤变（LSIL）符合率为33．93％（38／112）；②经宫颈活检证实为原位癌和SCC患者TCT与宫颈活检诊断的符合率为28．57％（26／91），假阴性率38．46％（35／91），经宫颈活检证实为腺癌患者TCT与宫颈活检诊断的符合率为50．00％（6／12），假阴性率41．67％（5／12）；③TCT提示HPV感染与宫颈HPuDNA检测的符合率为79．00％（173／219）；④宫颈高危型HPv-DNA阳性检出率与组织病理学分级正相关。[结论]TCT用于宫颈病变筛查，能够及时发现大量的宫颈病变，TCT结果为HSIL及宫颈癌的患者与宫颈活检诊断的符合率较高。TCT提示HPV感染有较高的准确性，但TCT对宫颈癌筛查有较高的假阴性率。对于TCT检查阴性、而临床高度可疑恶性病变、年龄较大的患者应予以重视，进一步做阴道镜检查及高危型HPVDNA检测和宫颈活组织检查，尤其是宫颈管诊刮，以降低宫颈癌的漏诊率。高危型HPV—DNA检测可以作为TCT诊断的客观控制指标，还可作为ASC—US及LSIL患者分流无病与患病人群的检查。
[Objective] To explore the value of liquid-based cervical cytology（TCT） for the diagnosis of cervical lesions and its significance. [Methods] The TCT screening results of 57,784 cases in out-patient clinic in Shengjing hospital affiliated to China Medical University were analyzed retrospectively. TBS（2001） report classification system was used in cytologic diagnosis. The positive diagnosis included ambiguous atypical squamous cell（ASC-US） and above lesions. Among them, 554 cases were positive by routine biopsy under colposcope, in which 317 cases performed cervical high-risk HPV：DNA testing. The results were compared among three groups. In addition, 103 cases of cervical cancer with TCT result which were confirmed by cervical biopsy were also compared. [Results]The diagnostic accordance rate of the positive result of TCT examination and cervical biopsy showed that 3 cases of squamous cell carcinoma （SCC） and 4 cases of adenocarcinoma were consistent with histopathologic diagnosis. The diagnostic accordance rate of highgrade squamous intraepithelial lesions（HSlL） and low-grade squamous intraepithelial（LSIL） were 86. 670/00 （91/105） and 33.93% （38/112）, respectively. Cervical biopsy confirmed that the diagnostic accordance rate of TCT and cervical biopsy in patients with in situ carcinoma and SCC was 28.57%（26/91）, and the false negative rate was 38. 46% （35/91）. The diagnostic accordance rate of TCT and cervical biopsy in patients with adenocarcinoma confirmed by cervical biopsy was 50. O0 % （6/12）, and the false negative rate was 41.67 % （5/ 12）. TCT suggested that the coincidence of HPV infection and HPV-DNA detection was 79.00% （173/219）. Cervical high-risk HPV- DNA positive rate was positively correlated with histopathologic grade. [Conclusion] TCT for the screening of cervical lesion can promptly detect a large number of cervical lesions. The diagnostic accordance rate of TCT results of patients with HSIL or cervical cancer and cervical biopsy is higher. T
出处
《医学临床研究》
CAS
2011年第1期27-32,共6页
Journal of Clinical Research
