薄层液基细胞学在宫颈病变筛查中的应用

　　【摘要】 目的 探讨薄层液基细胞学检测技术在宫颈病变筛查中的应用价值。方法 回顾性分析2007年3～7月间南京军区杭州疗养院妇科体检中3 580例ThinPrep液基细胞学检查结果,并对上皮细胞异常者进行随访以获得组织学病理结果,然后行对照相关性分析。结果 上皮细胞异常者190例,占5.31%,包括ASC-US 102例(2.85%),ASC-H 5例(0.14%),LSIL 69例(1.93%),HSIL 14例(0.39%)。通过随访获得167例阴道镜病理组织学结果,细胞学与组织学的诊断符合率为76.1%,细胞学为ASC-US者中有32.9%经病理证实为CIN。相关性分析提示TCT结果异常者检出CIN的风险(RR)远高于普通人群。组间比较得出, ASC-US组与LSIL组检出CINⅡ、CINⅢ/CIS的RR值差异没有统计学意义(P=0.26,0.76),ASC-US组与HSIL组检出CINⅠ的RR值差异也没有统计学意义(P=0.91),其他组间比较的差异均存在统计学意义(P<0.05,数据未显示)。结论 TCT技术应用于宫颈病变筛查,能有效提高宫颈癌前病变及宫颈癌的检出率,且结果与病理组织学对照符合率较高,是宫颈病变筛查的有效方法。对细胞学诊断为ASC-US者应予重视,及时进行高危型HPV检测,必要时进行阴道镜检查。

　　【关键词】 膜式薄层液基细胞学检测术(TCT);宫颈上皮内瘤变(CIN);筛查

　　【Abstract】 Objective To study the value of ThinPrep cytology test (TCT) in screening cervical intraepithelial lesion.Methods Examinination results of 3 580 cases who were received TCT in health examination in Hangzhou sanatorium ,Nanjing Military Command from March to July,2007 were retrospectively analyzed.The cases with abnormal result were followed up and confirmed by histopathologic examination.Correlation analysis was conducted.Results The results of TCT demonstrated that there were 190 cases with abnormal epithelial cells among 3 580 cases(5.31%),including 102 cases of ASC-US (2.85%),5 cases of ASC-H (0.14%),69 cases of LSIL(1.93%)and 14 cases of HSIL(0.39%).167 cases were received further pathological examination by colpomicroscope.The diagnose accordance rate of cytological and pathological examination was 76.1%.32.9% people with ASC-US were confirmed for CIN.The correlative analysis indicated that the risk ratio for detecting CIN in groups with abnormal epithelial cells confirmed by TCT was dramatically higher than that in common cases(P<0.05).There was no significant difference of the risk ratio for detecting CINII and CINIII/CIS between ASC-US and LSIL group(P=0.26,0.76).The same as the risk ratio for detectingCINI between ASC-US and HSIL group(P=0.91),whereas there was statistical significance between other groups(P<0.05).ConclusionApplication of TCT in screening cervical intraepithelial lesion caneffectively improve the detection ratio of cervical precancerosis as well as cervival cancer,and the diagnose accordance rate of TCT and pathological examination was relatively high,indicating TCT is an effective method for screening CIN.People with ASC-US should be focused and detected for high risk-HPV,and even received colposcopy examination if necessary.

　　【Key words】 ThinPrep cytology test;Cervical intraepithelia neoplasm;Screening

　　宫颈上皮内病变是女性最常见的疾患之一,其不断演变最终将发展为宫颈癌。宫颈细胞学检查是宫颈癌前病变及宫颈癌早发现、早治疗的重要手段和首选方法。现回顾性分析本院应用新柏氏膜式薄层液基细胞学检测(ThinPrep cytology test,TCT)技术对3 580例健康体检者进行宫颈病变筛查的结果,并通过随访其中上皮细胞异常者,对照分析其细胞学与组织学结果,探讨该技术在宫颈病变筛查中的应用价值。

　　1材料与方法

　　1.1一般资料2007年3～7月间我院妇科健康体检中

　　3 580例TCT检查结果,并对上皮细胞异常者进行随访以获得组织学病理结果,年龄25～73岁,平均(42.11±0.62)岁,中位数43岁。

　　1.2液基标本的采集及处理充分暴露宫颈,用塑料毛刷取样器采集宫颈外口及宫颈管处的脱落细胞,将采集的细胞洗入盛有ThinPrep保存液的小瓶中,经ThinPrep 2000系统程序化处理制成直径2 cm的薄片,95%乙醇固定,巴氏法染色,送浙江省肿瘤医院细胞病理室由专家阅片。

　　1.3细胞学诊断方法采用TBS系统(The Bethesda System)报告,宫颈病变的范围包括良性细胞改变及宫颈上皮内病变。宫颈上皮内病变根据程度可分为:非典型鳞状上皮细胞,意义不明确(atypical squamous cells of undetermined significance,ASC-US),非典型鳞状上皮细胞,不除外高级别鳞状上皮内病变(atypical squamous cells,cannot exclude high-grade squamous intraepithelial lesion,ASC-H),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),鳞状细胞癌(squamous cell carcinoma,SCC),非典型腺上皮细胞(atypical glandular of undermined significance,AGC)和腺癌。

　　1.4统计学处理结果采用spss 11.5统计软件处理,rr使用cochran's and mantel-haenszel统计分析,p

　　2.3细胞学结果与组织学病理结果的相关性分析因细胞学对asc-us的诊断缺乏可重复性和一致性,计算细胞学与组织学诊断符合率时指定细胞学阳性诊断为asc-us以上病变,不包括asc-us。细胞学诊断sil(squamous intraepithelial lesion)88例,病理组织学诊断cin(cervical intraepithelial neoplasm)67例,两者的诊断符合率为76.1%。细胞学与组织学结果的相关性分析提示tct结果异常者检出cin的风险(rr)远高于普通人群(表2)。

　　组间比较得出,tct提示asc-us组与lsil组检出cinⅱ、cinⅲ/cis的rr值差异没有统计学意义(p值分别为0.26、0.76),tct提示asc-us组与hsil组检出cinⅰ的rr值差异也没有统计学意义,其他组间比较的差异均存在统计学意义(p<0.05,数据未显示)。

　　3讨论

　　宫颈癌前病变至发展成宫颈癌是一个比较缓慢的过程,大约是5～10年。

（实习编辑：卢美仪）