液基薄层细胞学联合阴道镜在宫颈病变中的应用价值

目的探讨液基薄层细胞学检测(TCT)联合阴道镜下宫颈活检在宫颈病变中的临床应用价值。方法选择近年来在本院接受宫颈病变筛查的患者1685例,所有患者均行TCT检测,细胞学分类采用TBS分类标准,对其中128例TCT检查阳性者行阴道镜下多点活检。结果细胞学异常阳性检出率为7.60%(128/1685),其中不典型鳞状上皮细胞(ASCUS)56例(3.32%),低度鳞状上皮内瘤变(LSIU)42例(2.49%),高度鳞状上皮内瘤变(HSIU)26例(1.54%),宫颈鳞癌(SCC)3例(0.18%),宫颈腺癌(ACC)1例(0.06%)。阴道镜下病理诊断慢性炎症48例,轻度不典型增生(CINⅠ)41例,中度不典型增生(CINⅡ)17例,重度不典型增生及原位癌(CINⅢ)18例,宫颈鳞癌3例,宫颈腺癌1例。结论 TCT检查应用于宫颈病变的筛查,明显提高了宫颈病变的阳性检出率,联合阴道镜检查及镜下活检,能提高宫颈病变的诊断率,及时发现宫颈早期病变及癌变。     

TCT与阴道镜下活检在宫颈病变诊断中的应用

目的探讨液基薄层细胞检测系统（TCT）与阴道镜下活检在宫颈病变诊断中的应用价值。方法对TCT检查发现异常宫颈细胞涂片的296例,在阴道镜下行宫颈多点活检,比较两种方法的诊断符合率。结果TCT诊断为不典型鳞状细胞（ASCUC）的172例中,活检诊断为炎症者91例,诊断符合率为53.0%;TCT诊断为低度鳞状上皮内病变（LSIL）的69例中,活检诊断为宫颈上皮内瘤样病变（CIN）Ⅰ者54例,诊断符合率为78.3%;TCT诊断为高度鳞状上皮内病变（HSIL）的50例中,活检诊断为CINⅡ、Ⅲ者47例,诊断符合率为93.9%;TCT与活检对宫颈癌的诊断符合率为100%（均为5例）。结论TCT与阴道镜下活检检测宫颈病变具有较高的诊断符合率,两者联合检测可作为宫颈疾病的可靠诊断方法。     

宫颈非典型鳞状上皮细胞、人乳头状瘤病毒联合宫颈多点活检及宫颈管搔刮诊断老年宫颈疾病的价值

目的通过对宫颈细胞学检查结果为非典型鳞状上皮细胞(ASU-US)的中老年患者进行人乳头状瘤病毒(HPV)联合宫颈多点活检及宫颈管搔刮(ECC)检查的诊断价值。方法系统性回顾分析≥55岁的262例宫颈ASCUS患者的液基细胞学、高危型HPV定量检测(HC2-HPV DNA)、阴道镜检查和组织病理学检查资料。结果组织病理学确诊情况,良性病变177例(67.56%)、宫颈上皮内瘤变(CIN)Ⅰ38例(14.5%)、CINⅡ18例(6.87%)、CINⅢ23例(8.78%)和浸润性癌6例(2.29%)。相应的HC2-HPV DNA阳性率分别为9.6%(17/177),55.26%(21/38),88.89%(16/18),95.45%(21/23)和100%(6/6)。ECC所得的组织病理学为高级别鳞状上皮内病变(HSIL)6例,而对应患者活检完整组织块病理学结果分别为低级别鳞状上皮内病变(LSIL)和良性病变。HPV阳性组≥CINⅡ的检出率53.09%(44/81),阴性组为0(0/181),二者差异有统计学意义(P<0.05)。结论宫颈细胞学检查为ASC-US的患者中存在不小比例的HSIL(CINⅡ和CINⅢ),甚至浸润性癌。阴道镜下宫颈活检+宫颈管搔术有助于诊断,防止漏诊。对ASC-US患者及时进行HC2-HPV DNA检测,可作为ASC-US患者的分流手段,并采取规范诊疗措施能有效地发现潜在的HSIL或浸润性癌病变。     

液基薄层细胞检测结合阴道镜在宫颈癌及癌前病变筛查中的诊断价值

目的 探讨液基薄层细胞检测（TCT）和阴道镜在宫颈癌及癌前病变筛查中的应用价值.方法 对2009年1月-2010年12月在我院门诊就诊的2765例患者进行TCT检测,阳性结果患者在阴道镜指导下活检,将细胞学结果与组织病理学结果对照,评价TCT及阴道镜在子宫颈病变中的诊断价值.结果 2765例 TCT检测结果中,阳性219例,检出率为7.92%,包括ASCUS 101例 （46.1%）、AGCUS 4例（1.1%）、ASC-H 20例（9.1%）、LSIL 52例（23.7%）、HSIL 40例（18.2%）、SCC 2例（0.9%）.结论 TCT技术应用于宫颈涂片细胞学检查,配合阴道镜下活检是筛查和诊断宫颈癌及癌前病变的可靠手段.     

绝经后妇女宫颈不典型鳞状细胞特点及转归

目的 探讨绝经后妇女的超薄液基细胞技术（TCT）结果中性质不明的不典型鳞状细胞（ASCUS）的特点及转归。方法 对198例绝经后妇女的TCT结果为ASCUS者进行分析总结，96例直接进行了阴道镜检查取活检病理诊断，102例先观察3月后复查TCT。阴道镜活检病理结果为宫颈上皮内瘤变（CIN）和复查TCT结果仍为ASCUS的行二代杂交捕获（HC2）实验，检测人乳头瘤病毒（HPV）-DNA。结果 ①96例阴道镜检查取活检病理诊断为CIN的19例（Ⅰ级12例，Ⅱ级7例），7例CINⅡ级行宫颈锥切后3月复查TCT为正常；②102例观察3月再复查TCT持续为ASCUS的18例，2例宫颈低度鳞状上皮内瘤变（LSIL），二者的异常率比较无统计学差异（P〉0．05）；③阴道镜检查活捡病理为CIN和TCT持续为ASCUS的共39例，进行HC2HPV—DNA检测结果均为阳性。结论 绝经后妇女的ASCUS特点是宫颈病变的比率低，表明其转归较好；有宫颈病变的老年患者均感染HPV，提示ASCUS中的绝经后妇女HPV的检测及治疗对于预防老年宫颈癌发生有重要意义。     

液基薄层细胞学技术联合阴道镜检查筛查宫颈疾病的临床探讨

目的 探讨液基薄层细胞学技术(TCT)联合阴道镜下组织病理学检查对宫颈病变筛查的临床应用价值.方法 选择800例临床可疑患者进行宫颈病变筛查,其中380例进行TCT检查联合阴道镜活检(观察组),420例直接进行阴道镜活检(对照组),以组织学诊断为金标准,比较两组患者组织学诊断的阳性符合率.结果 观察组诊断符合率为75.0%(285/380),对照组诊断符合率为49.5%(208/420),两组检查结果比较,差异有统计学意义(P＜0.01).结论 TCT联合阴道镜活检能提高宫颈病变的诊断率,是筛查和诊断宫颈疾病的可靠手段.     

液基薄层细胞学联合阴道镜检查对宫颈癌及癌前病变的早期诊断价值

对1 032例液基薄层细胞学(TCT)阳性患者同时做阴道镜检查,并取活检与病理诊断作对照.发现1 032例患者中,意义不明的非典型鳞状细胞654例,低度鳞状上皮内病变118例,不能排除高度鳞状上皮内病变121例,高度鳞状上皮内病变122例,鳞状细胞癌17例.阳性检出率CIN Ⅰ 11.24%,CIN Ⅱ12.3%,CIN Ⅲ10.65%,SCC 3%.认为TCT联合阴道镜检查和病理诊断有较高的符合率,有利于宫颈癌及癌前病变的早期诊断.     

液基细胞学检查在宫颈病变中的诊断价值

采用ThinPrep液基细胞学检测了2 215例妇科病例,同时做宫颈巴氏涂片检测。细胞学诊断采用TBS分级系统。阳性诊断包括意义不明的非典型鳞状细胞（ASCUS）和意义不明的非典型腺细胞（AGUS）及以上的病变。细胞学诊断结果与阴道镜下多点组织活检病理结果对照。结果ThinPrep液基细胞学低度病变以上的诊断检出率较巴氏涂片增加了75.21%,低度病变及高度病变的检出率分别增加了67.02%和104.76%。提示ThinPrep液基细胞学检查大大提高了细胞学的诊断准确性。     

宫颈细胞学筛查及ASC-H诊断的临床指导意义

目的分析对液基细胞学诊断为非典型鳞状上皮细胞,不除外上皮内高度病变(ASC-H)和鳞状上皮高度病变(HSIL)的临床指导意义。方法将ASC-H及HSIL病例行阴道镜检查并取组织活检并对结果作对照分析。结果细胞学诊断为ASC-H的51例病例中,34例有组织学病理对照,其中10例慢性宫颈炎、3例CINⅠ、8例CINⅡ、11例CINⅢ、2例SCC,阳性检出率70.6%。68例HSIL病例中有46例组织学病理对照,其中1例CINⅠ、3例CINⅡ、33例CINⅢ、9例SCC,阳性检出率100.0%。结论宫颈细胞学结果为ASC-H有较高的CIN阳性预测价值,HSIL则高度提示有上皮内瘤变的存在,临床应予以极高度重视。     

ASC-H诊断的临床指导意义

目的 分析不除外高度上皮内病变的不典型鳞状上皮细胞(ASC-H)在宫颈病变中的诊断意义.方法 ASC-H病例行阴道镜检查并取活检,结果作对照分析.结果 细胞学诊断的40例ASCH病例中,33例有病理对照,其中有20例病理结果显示慢性宫颈炎,3例LSIL(低度鳞状上皮内病变)、8例HSIL(高度鳞状上皮内病变)、1例鳞状细胞癌(SCC)、1例息肉(polyp).结论 ASC-H有预示CIN2和CIN3的阳性价值.     

Repeat Cytology and Human Papillomavirus Screening Strategies in Detecting Preinvasive Cervical Lesions

The aim of the present study was to determine the value of human papillomavirus (HPV) testing in screening patients with preinvasive cervical lesions.Seven hundred thirty-four women diagnosed with atypical squamous cells of undetermined significance (ASCUS+) cervical cytology during routine screening had additional cytologic testing and HPV DNA testing within 6 months of their diagnosis, after which all women who tested positive were referred for colposcopy and biopsy. The test findings were then used to determine the screening value of HPV for diagnosing preinvasive cervical lesions.Cytology and HPV testing were compared by conventional cytology. The odds ratio (OR) of sensitivity using ASCUS+ or low-grade squamous intraepithelial neoplasia (LSIL+) as a cutoff for detecting cervical intraepithelial neoplasia (CIN) II+ was, respectively, 0.78 (0.72, 0.85) and 0.82 (0.70, 0.95) (P < 0.01). The cytology for triage and conventional cytology had different sensitivities using ASCUS+ or LSIL+ as the cutoff (P < 0.01). The cytology or HPV testing and conventional cytology had a difference in sensitivity using ASCUS+, LSIL+, or high-grade squamous intraepithelial neoplasia (HSIL+) as the cutoff (P < 0.01). Cytology and HPV testing were also compared with conventional cytology. The OR of specificity using ASCUS+ or LSIL+ as the cutoff for the detection of CIN II+ was 1.97 (1.68, 2.31) and 1.10 (1.02, 1.18), respectively (P < 0.01). The cytology for triage and conventional cytology had a difference in specificity when ASCUS+ or LSIL+ was used as the cutoff (P < 0.01). Finally, the cytology or HPV testing and conventional cytology had a difference in specificity when ASCUS+, LSIL+, or HSIL+ was used as the cutoff (P < 0.01).Cytology and HPV testing and cytology for triage improved the specificity of detecting CIN II+, but this did not improve the sensitivity. Additionally, cytology or HPV testing improved the sensitivity of detecting CIN II+ but not the specificity.     

宫颈细胞 HPV E6／E7 mRNA 检测在宫颈病变诊断中的价值

目的：评价高危型人乳头状瘤病毒（ HPV） E6/E7 mRNA检测对宫颈病变的诊断价值。方法520例患者采用b-DNA技术检测HPV E6/E7 mRNA,并用宫颈液基细胞学（ TCT）行宫颈细胞学检查,对其中任何一项阳性者做阴道镜下宫颈活组织检查,以组织病理为金标准,计算HPV E6/E7 mRNA阳性对高级别宫颈上皮内瘤样病变（ CIN）、宫颈浸润癌诊断的灵敏度、特异度、阳性预测值、阴性预测值,并与TCT检查进行比较。结果520例患者中HPV E6/E7 mRNA阳性158例, TCT异常222例。 TCT 异常者中HPV E6/E7 mRNA阳性率较TCT 正常者中HPV E6/E7 mRNA阳性率高（P＜0．05）。146例慢性宫颈炎、CINⅠ级患者与124例高级别CIN、宫颈浸润癌患者中HPV E6/E7 mRNA阳性率比较,P＜0．05。 HPV E6/E7 mRNA阳性对高级别CIN及宫颈浸润癌诊断的灵敏度、特异度、阳性预测值、阴性预测值分别为74．19％、83．33％、58．23％、71．43％,TCT 检查分别为81．53％、69．44％、81．45％、92．28％,两者特异度及阳性预测值比较, P均＜0．05。结论在宫颈癌筛查中检测高危型HPV E6/E7 mRNA对预测高级别CIN,尤其对评估癌症风险有重要的临床价值。     

Colposcopic appearance of anal squamous intraepithelial lesions

PURPOSE: The incidence of anal cancer is increased in men with a history of anal receptive intercourse. Analogous to cervical cancer, whose precursor is cervical high-grade squamous intraepithelial lesion (HSIL), anal cancer may be preceded by anal HSIL. Although not yet proven, detection, follow-up, and treatment of HSIL may prevent development of anal cancer. Cervical colposcopic methodology was used to describe anal lesions and to determine if HSIL could be distinguished from low-grade squamous intraepithelial lesion (LSIL). METHODS; The colposcopic characteristics of 385 biopsied anal lesions were described and correlated with results of histopathology in a cohort of 121 human immunodeficiency virus-positive and 31 human immunodeficiency-negative homosexual/bisexual men with anal lesions followed as part of a longitudinal study of anal squamous intraepithelial lesions. Color, contour, surface, and vascular patterns of anal lesions were analyzed and correlated with histologic diagnosis. RESULTS: Sixty-seven percent of biopsies showed LSIL and 26 percent showed HSIL. The positive predictive value for anal HSIL in lesions with characteristics typical of cervical LSIL was 7.7 percent (95 percent confidence interval, 1.8–14), whereas the positive predictive value for anal HSIL in lesions with characteristics typical of cervical HSIL was 49 percent (95 percent confidence interval, 40–58). CONCLUSIONS: The colposcopic appearance of different grades of anal squamous intraepithelial lesions was similar to those described for the cervix. Incorporation of colposcopy into assessment of anal disease could aid in distinguishing anal LSIL from HSIL.     

Touch Smear Cytology for Endoscopic Diagnosis of Gastric Carcinoma

A retrospective study was made on the accuracy of histology and touch smear cytology of the specimens obtained by endoscopic target biopsy. Sixty-five cases of small size excavated-type gastric carcinoma, including 27 cases of early carcinoma were studied.
By histology alone, 89% of cases (58 cases) were diagnosed accurately, 85% (55 cases) by touch smear cytology alone and 95% (62 cases) by combined examination. By touch smear cytology, 10 out of 16 specimens were diagnosed as positive, although extensive necrosis of the specimens prevented histologic study.
The study demonstrated that the floor as well as the edge and margin of the excavated lesion is an important target site for biopsy. Touch smear cytologic technic is an aid to the diagnosis of gastric malignancy.     

Risk of high-grade squamous intraepithelial lesion in HIV-infected adolescents

BACKGROUND: The risk of developing the human papillomavirus (HPV)-associated precancer high-grade squamous intraepithelial lesion (HSIL) in human immunodeficiency virus (HIV)-infected adolescents is unknown. We examined the risk of developing HSIL among adolescents with and without HIV infection. METHODS: HIV-infected (n = 172) and -uninfected (n = 84) girls aged 13-18 years who were participating in a multicenter study of primarily horizontally acquired HIV infections in adolescents (Reaching for Excellence in Adolescent Health Care) and who did not have HSIL on cytologic examination at study entry or at the first follow-up visit were followed at 6-month intervals. HIV-uninfected girls were recruited for comparison in a 2:1 ratio (HIV infected:HIV uninfected). The primary outcome was cytologic diagnosis of HSIL confirmed by expert review. RESULTS: Incidence of HSIL by the end of follow-up was higher for HIV-infected girls than for HIV-uninfected girls (21.5% vs. 4.8%, respectively). In multivariate analysis, use of hormonal (either estrogen/progesterone oral combination or medroxyprogesterone acetate intramuscular) contraceptives, high cervical mucous concentrations of interleukin (IL)-12, a positive HPV test, and persistent low-grade squamous intraepithelial lesion (LSIL) were significantly associated with the development of HSIL. CONCLUSIONS: The incidence of HSIL was alarmingly high in HIV-infected adolescent girls. However, when other predictors were considered in multivariate analysis, HIV status was not retained in the model. The heightened risk for HSIL associated with persistent LSIL underscores the need to closely monitor HIV-infected adolescents with LSIL. The risk for HSIL associated with high concentrations of IL-12 may be suggestive of a local immune dysregulation. The role of hormonal contraception as a risk factor deserves further investigation.     

Application of TruScreen in detecting ASCUS patients

ObjectiveTo explore the application of cervical cancer screening system, TruScreen in detecting atypical squamous cell of undetermined significance (ASCUS) patients.MethodsA total of 42 cases were selected, who were diagnosed as ASCUS by thinprep cytologic test (TCT). Area from site 15 to 20, site 21 to 32 were detected by TruScreen. And the result was compared with those of cases which had positive pathological result of cervical biopsy.ResultsThere were 16 cases with abnormal pathological result in ASCUS cases, including 6 cases with cervical intraepithelial neoplasia (CIN) I, 6 cases with CIN II, 3 cases with CIN III and 1 case with infiltrating carcinoma. The consistency between TCT and pathological test was 38.10% (16/42). The positive rate of TruScreen at site 15-20 was 61.91% (26/42). There was significant difference in consistency with pathological test between TCT and TruScreen (x²=4.762, P=0.029). The positive rate of TruScreen at site 21-32 was 66.67% (28/42)(Kappa=0.181, P=0.016). There was significant difference in consistency with pathological test between TCT and TruScreen (x²=9.4919, P=0.002). And no case was missed when site 21-32 of patients with CINII and above were detected by TruScreen.ConclusionsTruScreen is effective in detecting ASCUS patients.     

髙危型HPV检测在宫颈病变诊断中的价值

目的探讨高危型HPV检测在宫颈病变诊断中的价值。方法720例宫颈病变患者先进行HPV DNA的杂交捕获法二代（HPV—HCⅡ）和液基细胞学（TCT）的检测,其中224例因细胞学异常（意义未明的非典型鳞状细胞以及以上的病变）行阴道镜下活检。结果720例患者HPV阳性者264例（36．7％）,阴性者456例（63．3％）。HPV阳性组患者年龄（37．77±8．48）岁,HPV阴性组年龄（39．25±8．83）岁,两组比较P〈0．05。224例细胞学异常患者HPV感染率分别为炎症和复鳞上皮乳头瘤样增生64．9％（61／94）、宫颈上皮内瘤变（CIN）Ⅰ82．8％（24／29）、CINⅡ89．7％（26／29）、CINⅢ93．5％（58／62）、浸润癌100％（10／10）,随病理级别的升高HPV感染率显著升高（P〈0．05）。57例细胞学检测为ASC-US的患者中宫颈高度病变（≥CINⅡ）检出率为24．6％（14／57）,HPV阳性组检出率为33．3％（12／36）,阴性组为9．5％（2／21）,两组比较,P〈0．05,阴性组无浸润癌和CINⅢ的检出。87例细胞学为LSIL的患者中宫颈高度病变检出率为34．5％（30／87）,HPV阳性组检出率为39．5％（30／76）,阴性组为0,两组比较P〈0．01,阴性组无高度病变的检出。结论高危型HPV检测可以明显提高宫颈高度病变在细胞学为ASC-US及LSIL中的检出率。     

The prevalence and genotype distribution of human papilloma virus in cervical squamous intraepithelial lesion and squamous cell carcinoma in Taizhou,China

Human papillomavirus (HPV) infection is a common sexually transmitted disease worldwide and the leading cause of cervical cancer. Current vaccines do not cover all HPV genotypes whereas the distribution of HPV genotypes varies in different geographic regions. The study aimed to investigate the distribution of HPV genotypes in patients with cervical squamous intraepithelial lesion (SIL) and cervical squamous cell carcinoma (SCC) in Taizhou City of Jiangsu Province, China. A total of 940 patients including 489 cases with cervical low-grade squamous intraepithelial lesions (LSIL), 356 cases with cervical high-grade squamous intraepithelial lesions (HSIL), and 95 cases with cervical SCC, underwent a biopsy or surgery in Taizhou People''s Hospital between January 2019 and December 2019. The HPV testing results were retrospectively analyzed. The overall prevalence of any, high-risk, and low-risk HPV was 83.83%, 81.91%, and 12.13%, respectively. The 5 most common HPV genotypes were HPV16 (35.64%), HPV52 (16.91%), HPV58 (13.94%), HPV33 (8.94%), and HPV18 (7.98%). The prevalence of any and HR-HPV in SCC was significantly higher than those in LSIL and HSIL, while the prevalence of LR-HPV in SCC was significantly lower than those in LSIL and HSIL (P < .01). Single and dual HPV infections were prevalent in SCC, LSIL, and HSIL. Furthermore, the prevalence of dual HPV infection in SCC was significantly higher than those in LSIL and HSIL (P = .002). The HPV prevalence varied by age, being highest among women with SCC, LSIL, and HSIL aged 40 to 49 years, 40 to 49 years, and 50 to 59 years, respectively. In conclusion, the findings revealed a very high prevalence of HPV in women with cervical lesions in Taizhou. Routine HPV tests must cover all common HPV genotypes in clinical practice.