宫颈癌筛查中标本质量的评估方法

目的:探讨宫颈癌筛查中宫颈脱落细胞涂片标本质量的评估方法。方法:采用肉眼观察和显微镜下观察2种方法对经巴氏染色后的涂片质量进行评估。肉眼观察标本的涂片面积、涂片厚度;镜下观察鳞状上皮细胞数量、鳞状上皮细胞被遮盖情况、有无颈管柱状上皮细胞等指标。结果:肉眼观察19448张涂片,满意标本为91.76%,抽检的2082张镜下观察涂片,满意标本为76.85%。结论:在宫颈癌筛查中通过快速、便捷的肉眼+镜检相结合的方法,能迅速将质量评估结果和建议反馈给现场取样的医生,及时指导医生改进取样和涂片的方法,提高涂片标本的质量,以满足"子宫颈细胞学TBS报告系统"中对涂片标本质量的要求。     

3755例液基细胞检查在宫颈癌筛查中的应用分析

目的:探讨Thinprep液基细胞学薄层涂片在早期宫颈癌筛查的应用价值。方法:我院2004年9月～2006年9月采用新柏氏液基细胞技术(TCT)行宫颈细胞涂片筛查宫颈癌,共3755例,阳性结果717例,对其中242例经阴道镜下活检病理。结果:共检出阳性涂片717例,占19.1%,其中未明确意义的不典型鳞状上皮细胞(ASC-US)372例,占9.91%,不能除外高度鳞状上皮内病变的不典型鳞状上皮细胞(ASC-H)22例,占0.58%,低度鳞状上皮内瘤变(LSIL)247例,占7.30%;高度鳞状上皮内瘤变(HSLL)59例,占1.57%;鳞癌10例,占0.27%;非典型腺上皮细胞(AGC)7例,占0.19%。结论:采液基细胞学筛查,可早期发现宫颈癌前病变,及时配合阴道下活检,可提高早期宫颈癌变的诊断。     

颈管细胞和化生鳞状上皮细胞在宫颈病变检测中的意义

目的:调查宫颈液基细胞学检测中颈管细胞(EC)和化生鳞状上皮细胞(MSC)的有无是否与鳞状上皮内瘤变的检出相关,并分析EC和MSC的有无与经活体组织检查(活检)证实的病理结果之间的关系。方法:2008年1月～2010年12月17 815例宫颈液基细胞学涂片被列入研究。将液基细胞学标本中的上皮细胞成分与筛查结果进行统计,比较不同细胞成分下ASCUS、LSIL和HSIL的检出率,并对细胞成分与宫颈活检结果的关系进行分析。结果:总体中ASCUS检出率为4.95%,60～69岁组检出率最高(9.55%);LSIL总检出率为0.27%,40～49岁组检出率最高(0.42%);HSIL总检出率为0.19%,40～49组检出率最高(0.36%)。各年龄组细胞学异常总检出率均以EC(+)/MSC(+)组为最高,其次是EC(-)/MSC(+)组;ASCUS、LSIL及HSIL三组中经病理活检结果证实为CIN2及以上者比例最高组均为EC(-)/MSC(+),三组中所占比例分别为27.41%、50.00%、83.33%;EC(+)/MSC(+)次之,三组中所占比例分别为12.43%、42.85%、80.00%;结论:EC及MSC存在状态对宫颈细胞学异常的总检出率有影响,其中MSC与HSIL之间的关联更强。     

宫颈活检病理诊断与细胞学涂片结果不符的探讨

目的：提高对宫颈病变的细胞学诊断水平及探讨适应宫颈活检的情况。方法：复查本院2008—2012年宫颈活检病理诊断与细胞学涂片结果不符31例病理切片及细胞学涂片。结果：活检病理诊断：原位腺癌1例;CIN1（上皮内肿瘤1级）3例;CIN难分级1例;AIM（不典型不成熟鳞状细胞化生）6例;HPV（人乳头状瘤病毒）感染2例;ISM（不成熟鳞状细胞化生）6例;萎缩2例;慢性宫颈炎10例。结论：细胞学诊断的准确性直接关系到宫颈病变的检出,而其依赖于诊断医生的认识水平;细胞学判读结果为癌或HSIL（高级别鳞状上皮内病变）时直接做官颈活检,为LSIL（低级别鳞状上皮内病变）、ASC－H（非典型性鳞状细胞、不除外HSIL）、ASC－US（意义不明确的非典型性鳞状细胞）时至少要做阴道镜检查后,再决定是否做宫颈活检,AGC（非典型性腺细胞）倾向于肿瘤的,进行宫颈管活检、子宫内膜活检。     

宫颈细胞学涂片筛查宫颈病变895例临床分析

目的分析895例宫颈细胞学涂片结果临床特点。方法 895例患者纳入观察。采用液基薄层细胞检测系统(Thinprep Cytology Test,TCT)对宫颈病变进行检测,疾病诊断以组织学病理诊断为标准。结果 895例病例中,宫颈脱落细胞学涂片检查发现异常32例,检出率3.57%。其中不典型鳞状上皮细胞和腺细胞(ASC-US,AGc-US)17例,占总检出病例的53.1%;不除外高度鳞状上皮病变不典型鳞状细胞(ASC-H)3例,占总检出病例的9.4%;低度鳞状上皮内病变(LSIL)7例,占总检出病例的21.8%,高度鳞状上皮内病变(HSIL)3例,占总检出病例的9.4%,鳞状细胞癌(SCC)2例,占总检出病例的6.3%。各年龄段数据行率的两两比较(多重比较)(Scheffe法),p>0.05。且经比较,TCT与病理活检的符合率较高。结论宫颈细胞学涂片检查能有效的发现早期宫颈恶性病变,建议30～60岁妇女应每年进行1次宫颈细胞学检查。     

E-钙粘蛋白、β-环连蛋白、上皮细胞粘附分子在宫颈鳞状细胞癌癌变过程中的表达

目的:探讨细胞粘附分子E-钙粘蛋白、β-环连蛋白、上皮细胞粘附分子在宫颈鳞状细胞癌癌变过程中的表达和意义。方法:通过免疫组织化学方法检测3种细胞粘附分子在正常宫颈上皮、宫颈上皮内瘤变(CIN)、宫颈鳞状细胞癌中的表达情况。结果:①E-钙粘蛋白的阳性表达率从正常宫颈鳞状上皮、CIN至宫颈鳞状细胞癌逐渐下调;②β-环连蛋白的异常表达率从正常宫颈鳞状上皮、CIN至宫颈鳞状细胞癌逐渐增高;③上皮细胞粘附分子的过表达率从正常宫颈鳞状上皮、CIN至宫颈鳞状细胞癌逐渐增高;④E-钙粘蛋白的阳性表达下调及β-环连蛋白的异常表达与上皮细胞粘附分子的过表达相关,可能在宫颈癌变过程中起协同作用。结论:E-钙粘蛋白、β-环连蛋白、上皮细胞粘附分子参与了宫颈鳞状细胞癌的恶性转化过程,可做为宫颈鳞状细胞癌癌变过程中的分子生物学指标。     

利普液基细胞学在宫颈病变中的应用

目的:通过对利普液基细胞学(L iqu i-PREPtm,LPT)检测结果结合TBS报告与组织病理学结果报告,探讨LPT在宫颈病变中的应用价值以及对临床治疗的指导意义。方法:对2005年1~8月我院门诊261例宫颈糜烂患者进行妇科细胞学检查,采用L iqu i-PREPtm液基细胞学处理,将标本中黏液、血液和坏死碎片与上皮细胞分离,制成薄片细胞涂片,95%的乙醇固定,巴氏染色,TBS报告。阳性者取宫颈活检、组织病理学检查。结果:162例患者取材均为满意涂片。检出阳性结果宫颈鳞癌(SCC)9例,不典型鳞状上皮细胞不排除高度病变(ASC-H)2例,重度鳞状上皮内病变(HSIL)9例,轻度鳞状上皮内病变(LSIL)12例,不典型鳞状上皮细胞性质未定(ASCUS)2例,与组织病理学的符合率为93.8%。结论:L iqu i-PREPtm液基细胞学检测系统用于妇科细胞学检查,其阳性结果与组织病理学有较高的符合率,是行之有效的一种方法。     

北京市2013年适龄妇女免费宫颈癌筛查宫颈细胞学阅片质量控制结果分析

目的探讨2013年北京市宫颈癌免费筛查获得的宫颈细胞学阅片的质量控制情况,并进行相关分析。 方法自2013年在北京市16个区、县宫颈癌筛查机构接受宫颈癌免费筛查获取的286 781张宫颈涂片信息中,采用概率随机抽样法,随机抽取9 907张宫颈涂片进行质量控制结果分析。本研究以专家阅片结果作为宫颈细胞学诊断金标准,对传统巴氏涂片及液基细胞涂片的宫颈细胞学检出阳性率差异、各质量控制指标差异及涂片不满意率差异等进行统计学比较。 结果①液基细胞涂片的总检出阳性率、低度鳞状上皮内瘤变(LSIL)及高度鳞状上皮内瘤变(HSIL)的检出阳性率均较巴氏涂片高,且差异有统计学意义(2.41% vs 2.05%,χ²＝39.885,P＝0.000;0.58% vs 0.31%,χ²＝113.772,P＝0.000;0.14% vs 0.11%,χ²＝4.464,P＝0.035)。②抽取进行质量控制结果分析的涂片中,巴氏涂片与液基细胞涂片的假阴性率、特异度及符合率比较,差异均无统计学意义(P>0.05);巴氏涂片假阳性率较液基细胞涂片低,而其灵敏度较液基细胞涂片高,且差异均有统计学意义(0 vs 0.55%,χ²＝18.342,P＝0.000;100.00% vs 75.00%,χ²＝98.980,P＝0.000)。③本组宫颈涂片中,涂片不满意率为4.17%(413/9 907),首要原因为染色偏浅和(或)结构不清(54.24%);其次为细胞量不足(43.09%)。因细胞量不足导致的不满意率,巴氏涂片较液基细胞涂片高(2.45% vs 1.44%),而因染色偏浅和(或)结构不清导致的不满意率,则为液基细胞涂片较巴氏涂片高(3.34% vs 0.26%),且差异均有统计学意义(χ²＝12.452,93.311;P＝0.000)。 结论北京市宫颈癌免费筛查的宫颈细胞学检出阳性率有待进一步提高。建立完善的宫颈细胞学质量控制评价系统,对涂片的取材、制片及染色等环节加以控制,以提高涂片满意度及宫颈细胞学阅片质量。     

不除外宫颈高度鳞状上皮内病变的不典型鳞状细胞妇女应接受HPV DVA检测？

为分析评价HPVDNA检测。在细胞学为高度鳞状上皮内病变（ASC-H，HSIL）者的意义。回顾性分析2001--2003年所有使用TBS2001系统诊断为未明确诊断意义的不典型鳞状细胞（ASCUS）、不典型未成熟鳞状化生细胞（AISMT）、不典型鳞状化生细胞（ASMT）。并进行HPVDNA检测的液基薄层涂片，均有病理或细胞学随访，随访的类型有HSIL、低度鳞状上皮内病变（LSIL）、不典型细胞、正常涂片。两位细胞病理专家和一位细胞病理研究者分别阅片。排除ASCUS涂片。制片后用HC2方法保存标本，进行高危（HR）HPVDNA检测。删除可疑者。结果以阳性或阴性表示。     

阿勒泰市农村妇女宫颈液基细胞检查配合阴道镜筛查宫颈疾病效果分析

目的:探讨阿勒泰市农村妇女宫颈液基薄片细胞检查配合阴道镜筛查宫颈疾病的诊断价值。方法:对经过宣传动员自愿参加筛查的35～59岁阿勒泰市农村已婚女性进行妇科常规检查、阴道分泌物涂片、宫颈液基薄片细胞学检查、宫颈醋白试验、碘试验、阴道镜检查,结果异常者取宫颈活检送病理学检验,以病理学报告为诊断依据确诊宫颈癌患者。结果:1 046例筛查妇女中100例(研究组)行阴道镜下活检,病理报告显示原位癌1例(1.0%),浸润癌1例(1.0%),高度鳞状上皮内病变3例(3.0%),低度鳞状上皮内病变4例(4.0%);100例(对照组)肉眼观察异常下活检,病理报告显示低度鳞状上皮内病变1例(1.0%),高度鳞状上皮内病变1例(1.0%)。结论:宫颈液基薄片细胞检查配合阴道镜检查能及早发现宫颈癌前病变,是方便、经济、安全、可靠的检查方法,尤其适用于农村妇女宫颈疾病的筛查。     

“子宫颈糜烂”的发生机制及近现代观

一百多年前,子宫颈糜烂被描述为因炎症导致宫颈表层上皮脱失的一种宫颈形态。近现代观为:子宫颈糜烂是指位于宫颈外口的原始柱状上皮或早-中期的化生上皮,因雌激素影响,宫颈管内柱状上皮延伸至宫颈管外口,形成临床所见宫颈异位或外翻的典型外观。子宫颈糜烂曾被视作宫颈浸润癌的高危因素。现公认高致癌型人乳头瘤病毒(human papilloma virus,HPV)感染是发生宫颈浸润癌的核心因素。子宫颈糜烂与子宫颈癌的发生无关,对其治疗属过度医疗行为,应予以制止。     

宫颈新柏氏液基细胞学检查假阴性结果分析

目的分析宫颈新柏氏液基薄层细胞学检查(thinprepliquidbasedcytologictest,TCT)出现假阴性的原因。方法记录同时行TCT检查、高危型人乳头状瘤病毒(highrisk-humanpapillomavirus,HR-HPV)DNA检测及电子阴道镜定位活检病理检查的患者的检查结果 ,回顾性分析其中18例病理结果阳性而TCT结果阴性病例的TCT涂片,分别记录其细胞量、有无颈管细胞或化生细胞、是否为出血涂片、病灶与宫颈管距离及组织病理结果。结果原细胞学诊断阴性复查为阳性、细胞量<40%、无颈管细胞或化生细胞、出血涂片、重度炎症、病灶与宫颈管距离>1cm者,在假阴性病例中分别占5.56%、11.11%、44.44%、22.22%、11.11%、5.56%。TCT假阴性率高于TCT+HR-HPV假阴性率,差异有统计学意义(P<0.05)。结论规范取材方法 ,加强医师自身的阅片能力及应用更完善的技术(如TCT制片后加用计算机辅助细胞检测系统或TCT联合HR-HPVDNA检测)可以降低TCT假阴性率;临床医师对症状体征可疑但细胞学阴性的病例采取阴道镜下多点活检可减少假阴性的发生。     

A falsely reassuring cervical smear in adenocarcinoma of the external os

3 women with only mild changes in cervical smears were later found to be suffering from cervical adenocarcinoma. The first patient was 53 years old. Her smears repeatedly showed Pap 3 with moderately atypical glandular cells. After 3 colposcopic examinations with biopsies and 2 loop electrosurgical excision procedures of the cervix which showed no histological signs of malignancy, diagnostic conization revealed an adenocarcinoma of the endocervix. She underwent a radical hysterectomy and chemoradiation because of positive pelvic nodes. The second patient was 30 years old and had persistent vaginal discharge and an enlarged cervix, but no cytological abnormalities. Colposcopy was unsatisfactory and the tissue obtained by loop electrosurgical excision was normal. Adenocarcinoma was diagnosed after conization. She was treated with radical hysterectomy and radiotherapy but died after one year. The third patient, aged 26, had a long history of slightly abnormal Pap smears and vulvar condylomata, and was referred with vaginal discharge. A severe abnormal smear with glandular atypia was followed by colposcopical biopsies and conization, which revealed an endocervical adenocarcinoma. She underwent radical hysterectomy. Adenocarcinoma is a rare type of cervical cancer: III cases out of 584 patients with cervical cancer in 2003 in the Netherlands. This neoplasm is more difficult to detect than cervical squamous cell carcinoma. Cervical cytology is not an effective tool for screening and diagnosis. Due to the localization, multifocality and diversity in its presentation, the assessment of cytology has a high false-negative percentage. Screening may be enhanced by combining cytology with testing for high-risk HPV types, notably type 18. If cervical cytology shows persistent atypical glandular cells with no conclusive histological result, then due to the endocervical localisation of the lesions adenocarcinoma can only be excluded by conization.     

A repeat advice no longer applies for cervical smears without endocervical cells in population studies for cervical cancer

Recent Dutch and non-Dutch studies have shown that the absence of endocervical cells (ecc-) in an adequate cervical smear does not present an increased risk for the presence or occurrence of cervical cancer or premalignant abnormalities in a later phase. Based on these findings, the Coordination Committee Cervical Cancer Screening of the Dutch Health Insurance Council had advised dropping the repeat advice for non-abnormal ecc- smears by January 1st 2002. The National Health Insurance Council has agreed to this advice. The following measures have been taken: (a) no repeat advice for ecc- smears; in the case of negative findings the woman waits until the next five-yearly invitation from the screening programme; (b) whether the portio cervicis was seen has to be stated on the national request form; (c) the reporting of an ecc- in the cytology report and periodical feedback to general practitioners remains unchanged; (d) in the case of a non-abnormal ecc- smear with an uninspected portio or doubts as to whether the transformation zone was adequately scraped, either the smear will have to be repeated or the patient will have to be referred to the gynaecologist.     

A community-based cervical screening program in a remote Aboriginal community in the Northern Territory

Abstract: We established a culturally appropriate, community-based women's health service in Yuendumu, Northern Territory, to improve women's health and to remedy the low rate of cervical screening. During the 16 months of the program 419 cervical smears were taken, increasing coverage of the women eligible from 51 to 78 per cent Acceptance of the program was excellent, with only 2 per cent of the women approached refusing to have a smear. Over 70 per cent of the Pap smears were done by the nursing staff in the clinic; quality control was good, with 9 per cent of smears reported as having no endocervical cells. Sixty-four per cent of screened women had normal smears and 0.9 per cent showed evidence of cervical intraepithelial neoplasia (CIN). Three women were referred for treatment of CIN, two for CIN I and one for CIN III. The program illustrates how a combination of community involvement, staff stability, teamwork, and cross cultural understanding can achieve a comprehensive and successful cervical screening service in a remote Aboriginal community.     

液基细胞学技术与传统细胞学涂片检测宫颈鳞状细胞病变差异评价

目的比较液基细胞学技术与传统细胞学涂片在宫颈鳞状细胞病变检测中的差异。方法 2008年1月—2012年1月采用液基细胞学技术及传统细胞学涂片对1 880名妇女进行筛查,并对筛查阳性病例以阴道镜检查及病理活检结果为金标准作为阳性对照,评估液基细胞学技术对宫颈不同病变的诊断价值。结果液基细胞学筛查出非典型鳞状细胞(atypical squamous cells of undeter mined significance,ASCUS)及以上病例282例,阳性检出率为15.0%;传统细胞学涂片筛查出巴氏ⅡB级及以上病例84例,阳性检出率为4.5%。液基细胞学阳性检出率明显高于传统细胞学涂片,二者比较差异有统计学意义(P0.05)。以阴道镜及病理组织学检查结果为金标准,液基细胞学筛查符合率为73.40%,传统细胞学涂片筛查符合率为53.57%,二者比较差异有统计学意义(P0.05)。结论液基细胞学技术筛查宫颈鳞状细胞病变明显优于传统细胞学涂片。     

Characteristics and quality of Papanicolaou smears obtained by primary care clinicians using a single commercial laboratory.

BACKGROUND: Few data are available on factors associated with the quality of Papanicolaou smears performed in primary care. OBJECTIVE: To identify the patterns and proficiency of cervical cancer screening among different primary care specialties. MATERIALS AND METHODS: Clinical and cytologic data from 21,833 Papanicolaou smears, submitted to a single large commercial laboratory by 176 clinicians during a 7-month period, were correlated with individual clinician and specialty characteristics according to indexes of specimen quality. RESULTS: Obstetrician-gynecologists, nurse practitioners, and physician assistants provided screening to a younger population of women compared with family physicians, internists, and general practitioners. Factors positively associated with a greater probability of a "satisfactory" smear or the presence of endocervical cells (as a marker of adequate sampling) were increasing patient age, use of the cytobrush, and the specialty of the obstetrician-gynecologist. Satisfactory smears were not associated with any increased identification of cytologic abnormalities compared with "limited" smears. In contrast, smears with endocervical cells showed a higher proportion of abnormalities compared with specimens without such cells. CONCLUSIONS: Differences in the performance of obtaining Papanicolaou smears exist between primary care specialties, but need further clarification. The use of the cytobrush and the presence of endocervical cells are criteria that reflect clinician proficiency more realistically than the laboratory criterion of satisfactory smear.     

The optimal technique for obtaining a Papanicolaou smear with the Cervex-Brush.

BACKGROUND. The Cervex-Brush (Rovers, The Netherlands; Unimar, Wilton, Conn) is a cervical cytologic sampling device used to simultaneously collect endocervical and ectocervical cells. The optimal method for using this device to collect cervical epithelial cells for a Papanicolaou smear has not been described in the medical literature. METHODS. Using the Cervex-Brush, Papanicolaou smears were collected from 516 women in a prospective randomized study to evaluate five different clockwise rotation techniques: 180 degrees rotation of the brush, 360 degrees, 720 degrees, 1080 degrees, and 1800 degrees. The Bethesda System of classifying Papanicolaou smears was used to report cytologic results. Endocervical cell presence as an indicator of smear adequacy was quantitated from 0 to 4+. RESULTS. As the number of rotations was increased, the number of endocervical cells collected also increased (P less than .05). Abnormal epithelial cells were found in 22.3% of the smears obtained by rotating the brush 1080 degrees and 1800 degrees. This was compared with abnormal cells found in 8.2%, 4.5%, and 11.5% of the smears collected by rotating the brush 180 degrees, 360 degrees, and 720 degrees, respectively (P less than .001). Two smears that identified high-grade squamous intraepithelial lesions were collected using the 1800 degrees rotation. Unsatisfactory smears were obtained in 39 (7.5%) of the 516 smears. The percentage of slides containing hemorrhagic artifact was greatest (16.4%) in the 1800 degrees rotation group, but the likelihood of the Papanicolaou smear being considered unsatisfactory was not increased (P less than .05). CONCLUSIONS. Using a clockwise 1800 degrees rotation of the Cervex-Brush to obtain a Papanicolaou smear maximized the collection of endocervical cells, detected the greatest percentage of abnormal cells, and did not statistically exceed the acceptable limit for hemorrhagic artifact.