改良巴氏涂片法在宫颈病变筛查中的应用分析

传统巴氏涂片法在宫颈病变筛查中具有公认的成本低廉优势,但其检出率低是一个亟待解决的问题.我们对传统的巴氏涂片法从采样、固定、染色、报告方式等各方面进行了改良,并与传统法结果比较,效果满意.     

巴氏涂片与液基细胞学应用于宫颈病变筛查的临床比较分析

宫颈癌是妇科最常见的恶性肿瘤之一.其原因与女性过早的性生活、多产、人类乳头瘤病毒感染及人类免疫缺陷病毒感染等癌症高危因素有关.在全球范围内,每年约有20万女性死于宫颈癌.在发展中国家,宫颈癌则属于常见、多发的妇科肿瘤[1].据世界卫生组织统计每年全世界约有50万例新发生的宫颈癌,我国每年新发病例约13.15万例,占全世界的1/4[2].宫颈癌的发展是一个渐进的过程,不同级别的宫颈上皮细胞病变发展为宫颈癌的概率不同.从宫颈癌前病变发展成宫颈癌,有一个较长的过程,大约5～8年时间[3],这为宫颈病变的早期筛查提供了良好的时机.因此,早期筛查、防患于未然是防治宫颈癌的关键[4].近年来,在年轻女性中,其发病率有上升趋势,因此对宫颈癌的筛查越来越受到人们的关注.巴氏涂片细胞学检测作为宫颈癌的筛查方法,已有50多年的历史,虽然它的运用明显降低了宫颈癌的病死率[5],但它存在一定的局限性,尤其假阴性诊断令人担忧[6].宫颈液基细胞学在宫颈病变筛查方面,大大提高了宫颈病变的阳性检出率,使患者得到早发现、早诊断、早治疗,有效降低宫颈癌的发病率,2001年1月至2011年1月本院共有864例患者接受了宫颈病变的筛查.现就两种筛查方法的结果临床分析如下.     

液基细胞学离心沉淀涂片法与传统巴氏直接涂片法应用于宫颈疾病筛查的比较

<正>子宫颈癌是女性最常见的恶性肿瘤之一,又是一种可以通过防癌筛查得以早发现、早治疗、甚至彻底治愈的疾病。宫颈癌前病变(CIN)发展为宫颈癌有一个较长的过程(5～8年)[1],因此早期筛查、防患于未然是防治宫颈癌的关键[2],传统的宫颈癌筛查采用     

液基细胞学与传统巴氏涂片在宫颈上皮内病变的临床研究

巴氏涂片法作为宫颈病变的筛查方法已有50多年的历史,它的应用明显降低了宫颈癌的病死率,但巴氏涂片细胞学检查存在的假阴性诊断较为突出。液基细胞学技术是新兴的检查方法,已开始应用于临床宫颈病变的筛查。本研究旨在探讨液基细胞学技术与巴氏涂片技术在宫颈上皮内病变的诊断价值。     

宫颈细胞学涂片配合阴道镜检查诊断宫颈病变结果分析

子宫颈癌是妇科常见的恶性肿瘤之一。采用有效的检查方法，提高对宫颈疾病的早期诊断率是关键。宫颈涂片细胞学检查是宫颈癌及癌前病变最常用的筛查方法，但常规巴氏涂片中有高达20％。50％的假阴性率，阴道镜则是通过放大直接观察宫颈表面血管上皮的形态、结构加以评估病变，目前成为宫颈上皮内瘤样病变（CIN）和宫颈早期癌筛查的主要手段。本院采用宫颈细胞学检查配合阴道镜检查对早期宫颈病变进行筛查。现报道如下。     

液基薄层细胞检查与巴氏涂片在宫颈癌筛查中比较分析

目的比较液基薄层细胞学(TCT)与巴氏涂片对宫颈癌检查的准确性。方法对1 026位妇女同期做TCT、巴氏涂片检查及阴道镜活检。细胞学诊断采用TBS诊断报告方式。以阴道镜活检诊断为标准,比较TCT和巴氏涂片对宫颈癌检查的准确性。结果 TCT检查的敏感性为93.33%,特异性为97.45%,TCT对宫颈癌检查的敏感性及特异性均显著高于巴氏涂片(P<0.05,P<0.01),取材标本的不满意率降低了82.35%。结论 TCT对宫颈癌检查的准确性较高,可作为宫颈癌筛查优先选用的方法。     

宫颈癌筛查中液基薄层细胞学检查与巴氏涂片法的对比研究

目的评价液基薄层细胞学(TCT)检测法与传统巴氏涂片法对宫颈癌筛查的准确性比较。方法采用TCT和巴氏涂片法对1 015例成年妇女进行细胞学检测,细胞学诊断采用TBS分级系统,与组织学活检为阳性对照,进行统计学处理,评价TCT的诊断价值。结果 TCT和巴氏涂片法与组织活体检测的符合率分别为:鳞状上皮内低度病变(LSL)86.99%和64.38%;鳞状上皮内高度病变(HSL)92.08%和58.42%;鳞状细胞癌(SCC)100%和71.43%。结论 TCT在宫颈癌前筛查中价值明显优于传统巴氏涂片法。     

液基细胞学检测及巴氏涂片在宫颈癌筛查中的应用比较

目的:比较潮州农村地区宫颈癌筛查中液基细胞学检测(TCT)和巴氏涂片检测的应用价值.方法:采用分阶段整群抽样方法,选取潮州市5 个乡镇,招募35 ～ 59 岁的女性,同时行人乳头状瘤病毒(HPV)检测、TCT 和巴氏涂片检测,符合条件者进行阴道镜下活检和随访,评价TCT 和巴氏涂片检测的筛查效果.结果:3 723 例接受筛查女性中,总体而言,TCT 检测的灵敏度高于巴氏涂片(Fisher′s Exact Test,P ＜ 0.01),特异度、阳性预测值、阴性预测值无明显差异.两种检测方法的结果具有一致性(Kappa ＝ 0.14,P ＜ 0.001).巴氏涂片制片不满意率高于TCT(χ2 ＝ 64.3,P ＜ 0.001).结论:此次农村地区宫颈癌筛查中,相比巴氏涂片检测,TCT更为灵敏、制片效果更好,能提高宫颈病变的检出率,但诊断准确性没有明显差异.     

在博茨瓦纳对宫颈癌和宫颈巴氏涂片检查的知识和理解

在博茨瓦纳宫颈癌是最常见的恶性肿瘤，在女性居恶性肿瘤发病率和病死率的第一位。1990～1994年，1034名妇女被诊断为宫颈癌，占恶性肿瘤患的57．6％。同期有116名患死于宫颈癌，占恶性肿瘤死亡的52．2％。最近的统计表明，宫颈癌的发     

液基宫颈细胞学检查在宫颈病变筛查中的应用

2005年10月～2006年10月，我们采用液基超薄技术（TCT）对120例患者的宫颈细胞进行早期宫颈病变的筛查。现报告如下。     

人乳头瘤病毒检测及液基细胞学检查在宫颈癌筛查中的应用

目的比较人乳头瘤病毒(HPV)检测、液基细胞学检测在宫颈癌和癌前病变筛查中的应用价值。方法对门诊1 200例女性患者行液基细胞学检测(thinprep cytologic test,TCT),对256例患者行HPV-DNA检测。对结果阳性的患者进行阴道镜下宫颈组织病理学检测。结果行TCT检测的1 200例患者中阳性患者为50例,占所有标本的4.2%,行HPV-DNA检测的256例患者中,阳性患者为37例,占所有标本的14.5%。HPV-DNA检测的阳性检出率高于TCT检测,其差异有统计学意义(P<0.01)。结论 HPV检测、液基细胞学检测结合起来的检测方法,明显提高了诊断的准确性,较适合基层医院常规的筛查。     

A Pap test screening clinic in a South Asian community of Vancouver, British Columbia: challenges to maintaining utilization

The purpose of this article is to describe experiences and challenges in establishing a South Asian Pap Test Clinic. The specialized Pap test clinic for immigrant South Asian women was a community-initiated response to high rates of cervical cancer within this population. Efforts were made to ensure that the clinic provided health services in a sensitive and culturally appropriate manner. Although women were generally positive about their experiences at the South Asian Pap Test Clinic and often encouraged other women to attend the clinic for Pap testing, attendance patterns have not been maintained. The three most significant challenges to the clinic's ongoing success were: (1) maintaining the continued involvement of stakeholders in developing long-term strategies to enhance community awareness about cervical cancer; (2) creating mechanisms to strengthen support from physicians in the community; and (3) meeting the needs of the underserved within a specialized health service for South Asian immigrant women. These challenges provide important lessons for others to increase the participation of immigrant women in screening practices. Nurses can play a key role in mobilizing and maintaining collaborations that are essential to the continuing success of community-based programs.     

膜式薄层液基细胞学筛查宫颈病变结果对照分析

目的 研究河南濮阳地区宫颈癌及癌前病变的发病情况,探讨薄层液基细胞检测方法在筛查宫颈病变的作用和价值.方法 对2005年9月至2010年12月来濮阳市妇幼保健院门诊、住院女性患者进行膜式薄层液基细胞筛查34840例,将其中阳性者与组织病理诊断结果进行对照评估.结果 34840例样本中31750例无上皮内病变(91.13％),其中滴虫270例,真菌400例;宫颈肿瘤性病变3 090例,其中低度鳞状上皮内病变560例(1.60％),高度鳞状上皮内病变910例(2.60％),鳞状上皮细胞癌90例(0.26％),不典型腺细胞160例(0.46％),不典型鳞状上皮细胞1 060例(3.04％)(其中包括不除外高级别不典型鳞状上度细胞190例),人乳头状瘤病毒感染310例(0.89％).结论 膜式薄层液基细胞检测技术是目前筛查宫颈病变较为敏感及特异的方法,能够较早地发现、控制其发生发展,降低宫颈癌变率.     

液基细胞学检查、高危型人类乳头状瘤病毒DNA检测联合阴道镜对宫颈癌筛查的应用价值

目的探讨基液细胞学检查（TCT）、高危型人类乳头状瘤病毒（HPV）检测联合阴道镜对宫颈癌筛查的临床价值。方法选择2003年1月～2006年6月到该院就诊的652例患者,包括宫颈炎、宫颈湿疣、阴道不规则流血流液等患者,均为已婚妇女,无子宫颈锥形切除或子宫切除病史,无盆腔放射治疗史,年龄在23～65岁,均做液基细胞学检查和人类乳头状瘤病毒DNA检测。对TCT检查为意义不明的不典型鳞状细胞（ASC-US）以上、HPVDNA检测阳性、宫颈细胞学检查阴性,但肉眼观察可疑病例共157例行阴道镜检查。结果652例患者中,TCT诊断宫颈异常细胞阳性率18.40%,组织学阳性率12.34%,两者比较差异无显著性;高危型HPV检测,PCR检出率21.01%,与TCT检出率（13.65%）相比差异有显著性（P〈0.01）。联合阴道镜检查157例,拟诊CIN以上病变敏感性71.33%,特异性51.60%。结论TCT、高危型HPVDNA检测联合阴道镜可明显提高CIN的阳性检出率,降低漏诊率,是进行宫颈病变筛查的最佳方法,只有三者同时应用于癌前病变检查中,才能更好地发现宫颈癌前病变,阻断宫颈癌的发生。     

Effectiveness of nursing interventions to increase pap smear test screening

The purpose of this study was to determine the effect of a three‐stage nursing intervention to increase Turkish women's participation in Pap smear testing. Knowledge and beliefs about cervical cancer screening and barriers to Pap smears also were explored. In a quasi‐experimental study in a target population of 2,500 women, 237 completed pre‐test measures to inform the intervention, and an educational brochure was distributed to all 2,500. As a result, 510 women (20.4%) accepted free Pap smears. Of the remaining 1,990 women, 417 were randomly selected for telephone interviews, 302 participated, and 158 of these (52.3%) participated in free Pap smear testing. Of the 144 who did not have Pap smears after participating in telephone interviews, 54 were then interviewed face‐to‐face, and 20 (37.0%) decided to accept free Pap smears. A total of 668 women had accepted free Pap smears by the end of the intervention period. © 2013 Wiley Periodicals, Inc. Res Nurs Health 36:146–157, 2013     

Knowledge about cervical cancer screening among family physicians: cross-sectional survey

Background  Cervical cancer (CC) is an important public health problem worldwide. In Mexico, there has been a National Cervical Cancer Screening Program (NCCSP) since 1974. Mexican Social Security Institute attended Mexican workers and family physicians are responsible of the primary care of patients.
Objective  To evaluate knowledge about the aetiology and prevention of CC among family physicians working in Yucatan, Mexico, at Mexican Social Security Institute.
Methods  A questionnaire was applied to 187 family doctors. Self-administer questionnaire with 10 item previously used by ours and other researchers, was used for the evaluation. Each correctly answered item was given a point. The maximum grade was 10 and the minimum 0.
Results  The knowledge mean was 6.93 points. Fewer than 50% knew what to do with women who are human papillomavirus (HPV) positive without a precancerous cervical lesion and the appropriate age range for Pap smears. A total of 61.1% identified CC as an important health problem in Mexico; however, 95.1% identified CC as a preventive cause of deaths among Mexican women and recognized that HPV is the main CC aetiological agent, and 90.3% mentioned the Pap smear as the main method of diagnosis of CC.
Conclusion  The family doctors need to have an adequate knowledge of the practical elements of the NCCSP to give an efficient attention to their patients.     

高危型人乳头瘤病毒检测及TCT检测在宫颈病变筛查中的应用

目的：探讨高危型人乳头瘤病毒（HPV）检测及液基超薄层细胞检测技术（TCT）在宫颈病变筛查中的诊断价值。方法：对782例妇女进行TCT检测并采用二代杂交捕获技术进行HPV检测,其中TCT结果≥非明确意义不典型鳞状细胞（ASCUS）或HPV（＋）者行阴道镜下活组织检查187例以及同期因子宫良性病变行子宫全切术的妇女107例术前全部做HPV及TCT检测,病理结果为金标准。结果：若将TCT结果≥ASCUS,病理结果≥宫颈上皮内瘤变I级（CINI）确定为阳性,应用HPV检测的阴性预测值高于TCT,差异有统计学意义（P〈O．05）。若将TCT结果≥低度鳞状上皮内病变（LSIL）确定为阳性,病理结果≥CINⅡ确定为阳性,HPV检测灵敏度及阴性预测值高于TCT检测,特异度、阳性预测值低于TCT检测,差异有统计学意义（P〈0．05）;TCT≥LSIL,病理≥CINⅡ为阳性与TCT≥ASCUS,病理≥CINI为阳性的评价指标分析,HPV检测的灵敏度、两种检测方法的阴性预测值均有明显提高,差异有统计学意义（P〈O．05）。结论：可将HPV检测作为宫颈病变筛查的第一步,它是可靠的阴性预测值,具有临床推广意义。     

液基薄层细胞学在宫颈癌筛查中的应用

目的探讨液基薄层细胞学(LBP)在宫颈癌筛查中的应用价值。方法选取2010年1月至2014年9月于广东省第二人民医院行宫颈LBP检查的8 017例受检者为研究对象,根据年龄进行分组,观察结果阳性且愿意接受阴道镜及病理组织活检者的细胞学结果与组织学诊断的符合率。结果共有阳性人数703例,占8.8%,年龄17~70岁,40~49岁年龄组阳性率最高,达13.9%,各组间阳性率差异有统计学意义(χ2=25.741,P=0.000);共有566例患者随后接受了阴道镜检查和病理组织活检,占80.5%,细胞学与组织学结果总符合率为62.5%,高级别病变符合率100.0%。结论 LBP检查在宫颈癌筛查中具有操作简便、准确率高等优点,适合作为大范围宫颈癌筛查的首选方法。     

Monolayer超薄层宫颈涂片法筛查宫颈癌的价值

目的 对Monolayer超薄层宫颈涂片法筛查宫颈病变和宫颈癌进行方法学评价.方法 以组织病理学诊断为参比,应用受试者工作曲线的方法对Monolayer超薄层涂片法筛查宫颈病变和宫颈癌进行方法学评价.结果 本研究对象196人,以组织病理学诊断为参比,Monolayer超薄层涂片法筛查宫颈病变和宫颈癌的准确性为0.903 9(95%可信区间 0.8426,0.9651);若以磷状上皮内高度病变为临床阈值,则Monolayer超薄层涂片法筛查宫颈癌的敏感度和特异度分别为77.78%和92.70%,约登指数等于0.70.结论 Monolayer超薄层涂片法筛查宫颈病变和宫颈癌的准确性高,但是敏感性略显不足,约登指数等指标表明该法的综合诊断效能尚处中等水平.     

Women's lay knowledge of cervical cancer/cervical screening: accounting for non-attendance at cervical screening clinics

An assessment of women’s knowledge of cervical screening and cervical cancer was considered important as up to 92% of those dying from this form of cancer had never been tested. What were the reasons which determined their non-attendance? Issues to be addressed were reactions to invitation, women’s knowledge of screening, and the possible factors which they envisaged as being associated with cervical cancer. Other issues to be considered were practical problems associated with attendance, and preference for the sex and professional status of the health professionals involved; 187 women in a general practitioner practice in Lothian, Scotland were targeted by questionnaire. As with other studies in this field 50% of those contacted were ineligible for a variety of reasons. Seventy-two women completed the questionnaire, providing a mix of qualitative and quantitative data. Although the majority of women felt the invitation to attend screening was clear and easy to understand, there was a lack of knowledge with regard to both the screening itself and the possible causes of cervical cancer. The main ‘causes’ were seen as higher sexual activity among those aged under 37 and smoking and a virus by those over 37. The majority of women showed preference for a female professional to take the smear. Practical problems of time and venue were not considered insurmountable. The main reasons cited for non-compliance were the fear and dislike of the test itself.