摘要
目的评价宫颈液基细胞学、阴道镜和镜下宫颈组织病理学检查结果对宫颈病变的应用价值,以便早期发现和诊断宫颈上皮内瘤变和宫颈癌。方法北京市垂杨柳医院妇科门诊在2002年6月至2005年2月,行宫颈基薄层细胞学(TCT)初筛6 201例,对其中442例阳性和324例阴性但临床可疑宫颈病变共计766例,进一步行阴道镜及镜下取活检病理检查,以病理组织学为金标准,对诊断结果进行比较分析。结果TCT初筛6 201例,阳性病变442例,发病率7.13%,其中高度鳞状上皮内病变(HSIL)21例,低度鳞状上皮内病变(LSIL)82例,宫颈癌(CC)4例,意义不明的不典型腺细胞(AGUS)335例。阴道镜和病理诊断HSIL分别为34和36例,LSIL分别为143和153例,CC均为5例,炎症分别为584和572例。阴道镜对≥LSIL和≥HSIL诊断的Kappa值分别为0.887和0.868,均高于TCT对≥LSIL和≥HSIL诊断的Kappa值(0.615和0.716)。TCT和阴道镜诊断对≥LSIL以上病变的敏感性为53.1%和88.7%(P<0.01),特异性为99.3%和98.3%(P>0.05),符合率为87.6%和95.9%(P<0.01),漏诊率为46.9%和11.3%(P<0.01),阴性预测值为86.2%和96.2%(P<0.01),阳性预测值为96.3%和94.5%(P>0.05),误诊率为0.7%和1.7%(P>0.05)。335例ASCUS/AGUS病理诊断为宫颈炎症282例,宫颈上皮内瘤变(CIN)Ⅰ48例,CINⅡ3例,CINⅢ2例。结论液基细胞学可用于宫颈病变的初筛,液基细胞学检查联合阴道镜下活组织检查,可提高宫颈病变的检出率及准确率,可将二者联合用于宫颈上皮内瘤变的诊断。对ASCUS患者需进一步检查。
Objective To assess the value of liquid-based thinlayer cytology test（TCT）, colposcopy and biopsy in the diagnosis of cervical intraepithelial neoplasia and cervical cancer. Methods 6 201 outpatients in Department of Gynecology, Beijing Chuiyangliu Hospital, were given liquid thinlayer cytology examinations from June 2002 to February 2005, the positive cases of TCT were 442, with 324 TCT of negative results but suspected cervical lesions in clinical symptoms, both of 766 cases further underwent colposcopy and biopsy. Pathohistology was golden standard for the diagnoses of different methods. Results 442 cases were positive in 6 201 cases which were screened with TCT. The incidence was 7.13%, with TCT-diagnosed HSIL 21cases, LSIL 82 cases, CC 4 cases, ASCUS/AGUS 335 cases. Colposcopy and pathology diagnosed HSIL 34 cases and 36 cases, LSIL 143 cases and 153 cases, CC both 5 cases, inflammation 584 cases and 572 cases respectively. Compared with pathology, Kappa value of colposcopy checking ≥LSIL and ≥HSIL were 0. 887 and 0. 868, higher than Kappa value 0. 615 and 0. 716 of TCT checking ≥LSIL and ≥HSIL. The sensitivity of diagnosis≥LSIL with TCT and colposcopy were 53.1% and 88.7 % （ P 〈 0.01 ） respectively, specificity were 99.3 % and 98.3 % （ P 〉 0.05） respectively, total consistent rate were 87.6 % and 95.9 % （ P 〈 0.01） respectively, omission diagnostic rate were 46.9% and 11.3% （P 〈 0.01 ）, negative predictive valve were 86.2% and 96.2 % （ P 〈 0.01 ）, positive predictive valve were 96.3 % and 94.5 % （ P 〉 0.05 ）, misdiagnosis rates were 0.7 % and 1.7 % （P〉 0. 05） respectively. Among the 335 cases with ASCUS/AGUS diagnosed with pathohistology, the 282 cases with inflammation, 48 cases with CIN Ⅰ , 3 cases with CIN Ⅱ and 2 cases with CIN Ⅲ. Conclusion Liquid-based thinlayer cytology test used for preliminary screening, can be combined with colposcopic examination and biopsies for clinical diagnosis. In this way, the detection rate and accuracy of cervical diseases can be improved. ASCUS/AGUS cases need more sophisticated examinations.
出处
《首都医科大学学报》
CAS
2005年第5期607-611,共5页
Journal of Capital Medical University
关键词
液基薄层细胞学
阴道镜
宫颈上皮内瘤变
liquid-based thinlayer cytology
colposcopy
cervical intraepithelial neoplasia
