液基细胞学检测在宫颈癌筛查中的应用效果

目的探讨液基细胞学检测(TCT)在宫颈癌筛查中的应用效果。方法选取2015年6月至2016年12月间眉山市妇幼保健院收治的760例宫颈筛查患者,所有患者均行TCT检测,对于TCT阳性的患者行阴道镜检测,以病理诊断为金标准,观察分析TCT检测的准确度和特异度。结果760例患者中液基细胞学异常者159例(20.9%),其中不典型鳞状细胞(ASCUS)75例(9.9%),高度鳞状上皮内病变(HSIL)43例(5.7%),低度鳞状上皮内病变(LSIL)41例(5.4%)。159例患者阴道镜下宫颈活检术发现,宫颈上皮内瘤变(CIN)I患者73例(45.9%)。在75例ASCUS患者中,阴道镜检查CIN I 41例,CIN II 18例,TCT诊断符合率为78.7%;43例HSIL患者中,阴道镜检查CIN I14例,CIN II 18例,CIN III 6例,3例宫颈癌,符合率为95.3%;41例LSIL患者中,阴道镜检查CIN I18例,CIN II 13例,CIN III 3例,符合率为82.9%。结论 TCT检查在宫颈癌筛查中准确度较高,可为临床诊断提供一定的依据。     

液基薄层细胞学检测在宫颈癌及癌前病变筛查中的应用

目的:分析液基薄层细胞学检测（thin-cytologic test,TCT）在宫颈癌筛查中的应用以及其与宫颈癌前病变及宫颈癌发生的相关性。方法:纳入2016年10月-2018年10月于我院妇科门诊进行宫颈筛查的患者2 702例,所有患者均接受液基薄层细胞学检测、HPV-DNA检测及宫颈组织病理活检,比较2 702例患者TCT检测与HPV-DNA检测及组织病理学结果的符合率。结果:TCT检查结果中,LSIL、HSIL、宫颈癌分级与病理活检结果符合率分别为26.21%、61.62%、93.94%;这提示TCT筛查对高级别宫颈病变的敏感性高。随着病理级别的升高,HPV-DNA检测与TCT检测结果的阳性符合率也逐渐升高,LSIL、HSIL、宫颈癌级别的HPV阳性符合率分别为52.97%、70.03%、100.00%,组间比较差异具有统计学意义,P＜0.05。结论:液基薄层细胞学检测在宫颈癌以及癌前病变的筛查中具有较高的准确性,可以通过TCT检查进行早期宫颈癌及癌前病变的筛查,从而及时采取措施降低宫颈癌的发病率。     

液基薄层细胞学检查及TBS报告系统在宫颈病变筛查中的应用

目的探讨液基薄层细胞制片术和TBS报告系统在子宫颈病变筛查中的价值。方法随机收集635例患者宫颈脱落细胞液基标本,采用液基薄层细胞制片技术和TBS报告系统诊断,对细胞学诊断阳性病例行阴道镜活检和组织病理学诊断,所有诊断均双盲进行。结果635例中检出100.00%(6/6)的鳞状细胞癌(SCC),检出93.33%(14/15)的高级别鳞状上皮内病变(HSIL),检出91.43%(32/35)的的低级别鳞状上皮内病变。结论液基薄层细胞制片和TBS报告系统对宫颈病变检出阳性率较高,与组织学检查的诊断符合率较高,是临床宫颈病变筛查的好方法。生育年龄段的妇女应定期行液基薄层细胞学筛查。     

液基细胞学与阴道镜联合应用对宫颈癌前期病变的临床意义

目的评价液基薄层细胞学检测(Thin prep Cytology Test,TCT)与阴道镜联合应用诊断宫颈癌前期病变的准确性。方法2004年1月-2006年12月在我院妇科门诊对10 129例已婚受检者行TCT检查,其中对1 452例阳性诊断结果做阴道镜活检。细胞学诊断采用TBS分级系统,阳性诊断包括上皮细胞异常,诊断结果与阴道镜活检诊断对照。结果10 129例宫颈液基细胞学检查中,1 452例(14.33%)细胞学检查异常,其中ASC477例(占4.71%),LSIL462例(占4.56%),HSIL366例(占3.61%),AGC129例(占1.27%),CA18例(占0.18%)。在细胞学检查异常的1 452例病例中,宫颈活检慢性炎占55.99%,CINⅠ占25.41%,CINⅡ占14.05%,CINⅢ/原位癌27例占1.86%,CA39例占2.69%,TCT与阴道镜下宫颈活检阳性符合率为86.02%。结论TCT检查与阴道镜下定位活检、病理检查结合可提高宫颈上皮内瘤样病变诊断的准确率。     

利普液基细胞学(LPT)在宫颈病变诊断中的价值

目的:探讨利普超薄液基细胞学制片技术(Liquid-Prep Test, LPT)在宫颈病变中的应用价值.方法:7 000例患者接受LPT宫颈液基细胞学检查.部分结果异常者做阴道镜检查或宫颈多点活检进行组织病理学检查对照.结果:92例LPT宫颈细胞学检查与组织病理学对照结果显示:鳞状细胞癌(SCC)符合率最高,为100%(9/9),其次鳞状上皮内高度病变(HSIL)为90.91%(20/22),鳞状上皮内低度病变(LSIL)为72.41%(21/29).腺癌(AC)为100%(1/1).结论:LPT液基细胞学检查的敏感性高,它能准确地反映宫颈癌和癌前病变,是一种有效的宫颈癌的筛查手段.     

液基薄层细胞学检测子宫颈病变4234例临床病理分析

 目的　评价液基薄层细胞学检测（TCT）在子宫颈病变筛查中的意义。方法　采用TCT系统采集子宫颈细胞学标本4234例,按照TBS系统（the Besthesda system） 进行判读。对细胞学筛查为异常的272例[意义不明确的非典型性鳞状细胞（ASC-US）或以上病变]进行阴道镜下活组织病理检查。结果　TCT与阴道镜下活组织病理检查结果符合率为低度鳞状上皮内病变（ LSIL）85.71 %（12／14）、高度鳞状上皮内病变（HSIL）100 %（20／20）、鳞状细胞癌（ SCC）75.00 %（3／4）、腺癌（AC）100 %（2／2）。TCT诊断不除外高级别鳞状上皮内病变的非典型性鳞状细胞（ASC-H）以上病变的阳性率为23.16 %（63／272）,活检病理组织学诊断子宫颈上皮内瘤样低度病变（CINⅠ）以上病变的阳性率为24.26 %（66／272）,二者比较差异无统计学意义（χ2＝0.868,P＝0.581）。结论　TCT与活组织病理检查诊断有较高的符合率,二者结合能大大提高对子宫颈的高度病变和子宫颈癌的检出率,减少漏诊。TCT可作为子宫颈癌及癌前病变筛查的一种高效、便捷的方法。     

TCT制片质量控制和宫颈癌诊断

目的:探讨液基细胞学(TCT)制片质量控制方法以及筛查宫颈癌的优点.方法: 分析18500例液基细胞学制片技术的取材、涂片、染色等过程质量控制方法,并筛查出阳性者诊断,包括宫颈癌、鳞状上皮内高度病变,与活检和HPV DNA阳性检出率对照.结果: TCT优片率98.8%(18287/18500),TCT检出的和活检检出宫颈癌100%(18/18),CIN3级97%(30/31),CIN2级90%(42/46),HPVDNA阳性检出率与细胞学分级密切相关且在细胞学与组织学相同级别基本一致.结论: TCT制片质量控制有利于提高制片质量及宫颈癌、鳞状上皮内高度病变诊断,TCT检查敏感性高,可作筛查宫颈癌的检查.     

TCT及阴道镜检查对宫颈病变诊断的临床价值

为了探讨液基薄层细胞学技术(thin prep cytologic test,TCT)及阴道镜检查对子宫颈病变的诊断价值,收集6 521例患者及健康体检者,进行TCT检测,TCT阳性者行阴道镜检查及活检.TCT异常者688例(10.55%),TCT和阴道镜对低度鳞状上皮内瘤变(LSIL)的检出率分别为63.96%(158/247)和70.04%(173/247),高度鳞状上皮内瘤变(HSIL)为73.03%(65/89)和84.27%(75/89),宫颈浸润癌(CC)为81.82%(27/33)和96.97%(32/33).初步研究结果提示,TCT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.中华肿瘤防治杂志,2009,16(10):789-790     

液基细胞学在子宫颈病变诊断中的应用

目的 探讨液基细胞学(TCT)在子宫颈病变诊断中的价值.方法 收集2008年12月至2009年12月在该院妇科门诊就诊患者2134例,经Thinprep2000系统处理,制成薄层细胞涂片,经95%乙醇固定,巴氏染色.受检病例中有92例细胞学检查结果 异常行阴道镜子宫颈活检.结果 受检的2134例中ASC-US 27例(1.27%),ASC-H 14例(0.06%),LSIL 34例(1.60%),其中4例提示HPV感染,HSIL 11例(0.52%),SCC 2例(0.09%),AGUS 4例(0.19%).TCT检出的ASC-US 27例,活组织榆查有4例为CINⅠ,4例为CINⅡ,其余为炎症;检出 ASC-H 14例,CN和SCC 8例,其余为炎症;检出AGUS4例,活检2例为子宫内膜腺癌,2例为炎症.TCT与病理活检的阳性符合率:LSIL为67.65%(23/34),HSIL为90.9l%(10/11),SCC为100%(2/2).结论 液基细胞学检测对子宫颈病变的检出率高,适合普查及门诊检查,对子宫颈癌的早期诊断有很重要的应用价值,值得推广.     

液基薄层细胞学检测联合宫颈活检对诊断宫颈鳞状上皮病变的临床价值

目的:探讨液基薄层细胞学检测(liquid-based thinPrep cytology test,TCT)联合宫颈活检对诊断宫颈鳞状上皮病变的临床价值.方法:应用TCT对30350例受检者进行宫颁细胞学检查,细胞学检查结果为鳞状上皮异常者,进行阴道镜活检及病理检查.结果:TCT检出鳞状上皮异常者1 824例(6.01％),其中无明确意义的不典型鳞状细胞(atypical squamous cells of undetermined significance,ASC-US)1423例,不除外高度鳞状上皮病变的不典型鳞状细胞(atypical squamous cells cannot exclude high grade intraepithelial lesion,ASC-H)214例,低度鳞状上皮内病变(low grade squamous intraepithelial lesion,LSIL) 92例,高度鳞状上皮内病变(high grade squamous intraepithelial lesion,HSIL) 80例,鳞状细胞癌(squamous cell carcinoma,SCC) 15例.与活检病理检测结果相比,1423例ASC-US中,宫颁上皮内瘤样病变-Ⅰ级(grade Ⅰ cervical intraepithelial neoplasia,CIN-Ⅰ)202例、CIN- Ⅱ和CIN- Ⅲ 22例、SCC 1例;214例ASC-H中,CIN-Ⅰ 12例、CIN-Ⅱ和CIN-Ⅲ 101例、SCC5例:LSIL、HSIL及SCC组中与组织病理检测结果的符合率分别为63.04％( 58/92)、81.25％ (65/80)及100％( 15/15),SCC组和HSIL组的组织学符合率高于LSIL组(P＜0.01).结论:TCT与阴道镜活检病理检测结果有较高的符合率,二者联合能提高宫颈癌前病变及癌变的检出率.     

液基细胞学筛查宫颈癌的研究

目的 评价ThinPrep液基细胞学在宫颈癌高发区筛查的准确性。方法 1997年例受检者同时做宫颈脱落细胞液基标本采集和阴道镜活检,用液基标本做薄片细胞学诊断和肿瘤相关人乳头瘤病毒（human papilloma virus,HPV)检测。细胞学诊断采用TBS分级系统,阳性诊断包括意义不明的不典型鳞状细胞（ASCUS）以上病变,诊断结果与阴道活检诊断和肿瘤相关HPV DNA阳性检出率对照。所有检查均双盲进行。结果 ThinPrep液基细胞学检出100％（12／12）的鳞状细胞癌（SCC）;93．2％（69／74）的鳞状上皮内高度病变（HSIL）,其中CIN396．8％（30／31）,CIN90．7％（39／43）;72．4％（92／127）的鳞状上皮内低度病变（LSIL）。SCC和CIN3的分级准确率分别达100％和87．1％。HPVDNA阳性检出率与细胞学分级密切相关,且在细胞学与组织学相同级别基本一致。结论 宫颈液基标本收集方法有利于细胞学和肿瘤相关HPV DNA双重检查。ThinPrep液基细胞学检查敏感性高,尤其是对鳞状上皮内高度病变。     

液基薄层细胞学筛查宫颈癌及癌前病变的研究

目的：评价液基薄层细胞学检查（ＴＣＴ）结合伯塞斯达系统（ＴＢＳ）诊断宫颈病变的准确性。方法：ＴＣＴ结合ＴＢＳ对６６８例受检者的宫颈脱落细胞进行细胞学诊断,将ＴＢＳ报告的意义不明的不典型鳞状细胞（ＡＳＣＵＳ）、低度鳞状上皮内病变（ＬＳＩＬ）、高度鳞状上皮内病变（ＨＳＩＬ）以及鳞状细胞癌（ＳＣＣ）列为细胞学阳性病例。对阳性病例进一步采用阴道镜下活组织病理学检查。采用Ｓｐｅａｒｍａｎ等级相关分析对细胞学和组织学检查结果的相关性进行评价。结果：ＴＣＴ共检出７６例细胞学阳性病例,占全部受检病例的１１.３８％。阴道镜下活组织病理诊断结果为宫颈上皮内瘤变（ＣＩＮ）３８例和ＳＣＣ１例。Ｓｐｅａｒｍａｎ等级相关分析显示细胞学和组织学检查结果高度正相关（ｒ＝０.８０８１,Ｐ＝０.０００）。结论：ＴＣＴ技术结合ＴＢＳ的细胞学检查是一种可靠的宫颈癌及癌前病变筛查手段。     

The significance of the Papanicolaou smear diagnosis of low-grade squamous intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion

BACKGROUND: Cervical cytologic specimens that show a low-grade squamous intraepithelial lesion (LSIL) occasionally contain a few cells that are suspicious for, but not diagnostic of, a high-grade squamous intraepithelial lesion (HSIL). In such cases, a diagnosis of LSIL cannot exclude HSIL is rendered. The objective of the current study was to assess the positive predictive value (PPV) for HSIL in follow-up cervical biopsies for these cases. METHODS: One hundred forty-four women with a Papanicolaou (Pap) diagnosis of LSIL cannot exclude HSIL and their follow-up cervical biopsies were reviewed. Results were compared with a control group of 155 women with a Pap diagnosis of LSIL. A subset of biopsies was tested and typed for human papillomavirus (HPV) DNA by polymerase chain reaction amplification using consensus primers followed by restriction fragment length polymorphism analysis. HPVs were scored as low-risk or high-risk types. RESULTS: Women with LSIL cannot exclude HSIL had a higher incidence of HSIL (PPV = 29%) on follow-up cervical biopsy than the control group (PPV = 15%, P < 0.01). In addition, SIL, indeterminate grade was diagnosed in 10% of cervical biopsies in the study group as compared with 4% in controls. Review of Pap smears from the study group showed that there were 3 types of cells suspicious for a high-grade lesion: atypical squamous metaplastic cells (62%), atypical keratinized cells (20%), and dysplastic cells of borderline nuclear-to-cytoplasm ratio (18%). HPV analysis confirmed the presence of high-risk HPV types in the study cases with high-grade cervical biopsies. CONCLUSIONS: Women with a Pap diagnosis of LSIL cannot exclude HSIL appear to be more likely to harbor a high-grade lesion than those diagnosed with LSIL alone. Its use appears warranted. Women with this diagnosis merit appropriate clinical follow-up to exclude HSIL.     

Quantitative Detection of Screening for Cervical Lesions with ThinPrep Cytology Test

OBJECTIVE To investigate the available parameters in gynecological screening for cervical lesions by liquid-based cytology technology (ThinPrep Cytology Test, TCT) and The Bethesda System (TBS), also with computer image analysis. METHODS With application of the image analysis system, all grades of cervical lesion cells were detected quantitatively and sorted in atypical squamous cells of undetermined significance (ASCUS), atypical squamous cells-cannot exclude HSIL (ASC-H), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL) and cervical squamous cell carcinoma (SCC) with the mean optical density (MOD), average grey (AG), positive units (PU), and nucleus to cytoplasmic ratio (N:C). Differences between each group of cells were compared and analyzed statistically.RESULTS Apart from four stereologic parameters in LSIL and HSIL groups there were no differences among them, in the other groups, there was statistically significant in differences between MOD, AG and PU values. Differences between them in the ratio of nucleus to cytoplasm were highly statistically signifi cant. CONCLUSION Stereological indexes may serve as a screening tool for cervical lesions. The image analysis system is expected to become a new means of cytological assisted diagnosis.     

Application of Human Papillomavirus in Screening for Cervical Cancer and Precancerous Lesions

Cervical cancer is a commonly-encountered malignant tumor in women. Cervical screening is particularlyimportant due to early symptoms being deficient in specificity. The main purpose of the study is to assess theapplication value of cervical thinprep cytologic test (TCT) and human papillomavirus (HPV) detection in screeningfor cervical cancer and precancerous lesions. In the study, cervical TCT and HPV detection were simultaneouslyperformed on 12,500 patients selected in a gynecological clinic. Three hundred patients with positive resultsdemonstrated by cervical TCT and/or HPV detection underwent cervical tissue biopsy under colposcopy, andpathological results were considered as the gold standard. The results revealed that 200 out of 12,500 patientswere abnormal by TCT, in which 30 cases pertained to equivocal atypical squamous cells (ASCUS), 80 casesto low squamous intraepithelial lesion (LSIL), 70 cases to high squamous intraepithelial lesion (HSIL) and 20cases to squamous cell carcinoma (SCC). With increasing pathological grade of cervical biopsy, however, TCTpositive rates did not rise. Two hundred and eighty out of 12,500 patients were detected as positive for HPVinfection, in which 50 cases were chronic cervicitis and squamous metaplasia, 70 cases cervical intraepithelialneoplasia (CIN) Ⅰ, 60 cases CIN Ⅱ, 70 cases CIN Ⅲ and 30 cases invasive cervical carcinoma. Two hundred andthirty patients with high-risk HPV infection were detected. With increase in pathological grade, the positive rateof high-risk HPV also rose. The detection rates of HPV detection to CIN Ⅲ and invasive cervical carcinoma aswell as the total detection rate of lesions were significantly higher than that of TCT. Hence, HPV detection is abetter method for screening of cervical cancer at present.     

TCT制片质量控制和宫颈癌诊断

目的：探讨液基细胞学（TCT）制片质量控制方法以及筛查宫颈癌的优点。方法：分析18500例液基细胞学制片技术的取材、涂片、染色等过程质量控制方法，并筛查出阳性者诊断，包括宫颈癌、鳞状上皮内高度病变，与活检和HPVDNA阳性检出率对照。结果：TCT优片率98．8％（18287／18500），TCT检出的和活检检出宫颈癌100％（18／18），CIN3级97％（30／31），CIN2级90％（42／46），HPVDNA阳性检出率与细胞学分级密切相关且在细胞学与组织学相同级别基本一致。结论：TCT制片质量控制有利于提高制片质量及宫颈癌、鳞状上皮内高度病变诊断，TCT检查敏感性高，可作筛查宫颈癌的检查。