宫颈细胞学不明确意义不典型鳞状细胞结果的分流处理

重复细胞学检查、人乳头瘤病毒(HPV)检测或立即阴道镜为当前处理不明确意义不典型鳞状上皮细胞(ASCUS)最常用的方法.但这3种方法存在高漏诊率和误诊率、主观性强等不足,HPV持续感染、整合感染、宿主细胞基因不稳定及细胞恶性转变的生物学标记可更客观、有效地分流ASCUS.基于生物标记的多参数立体化检测可能成为分流异常细...     

宫颈锥切术在诊断宫颈病变中的价值分析

目的：探讨宫颈锥切术能否被阴道镜多点活检所代替以及宫颈锥切术在诊断宫颈上皮内瘤样病变（CIN）和早期宫颈癌中的价值。方法：回顾分析2007年1月-12月在江西省妇幼保健院肿瘤科因宫颈病变同时行阴道镜多点活检和宫颈锥切术（包括冷刀和电圈环切术即LEEP术）的患者120例,采用自身对照法,研究宫颈锥切术和阴道镜多点活检的病检结果的差异。结果：宫颈锥切术与阴道镜下多点活检病理符合者59例（49.17%）;不符合者61例（50.83%）,宫颈锥切术后病理诊断加重者35例（占29.17%）,浸润癌漏诊率10.00%。结论：宫颈锥切术在诊断C IN和早期宫颈癌中具有重要价值,不能被阴道镜多点活检所取代。要重视切缘是否阳性并加强术后随访。     

宫颈锥切术在诊断宫颈病变中的价值分析

目的:探讨宫颈锥切术能否被阴道镜多点活检所代替以及宫颈锥切术在诊断宫颈上皮内瘤样病变(CIN)和早期宫颈癌中的价值。方法:回顾分析2007年1月-12月在江西省妇幼保健院肿瘤科因宫颈病变同时行阴道镜多点活检和宫颈锥切术(包括冷刀和电圈环切术即LEEP术)的患者120例,采用自身对照法,研究宫颈锥切术和阴道镜多点活检的病检结果的差异。结果:宫颈锥切术与阴道镜下多点活检病理符合者59例(49.17%);不符合者61例(50.83%),宫颈锥切术后病理诊断加重者35例(占29.17%),浸润癌漏诊率10.00%。结论:宫颈锥切术在诊断C IN和早期宫颈癌中具有重要价值,不能被阴道镜多点活检所取代。要重视切缘是否阳性并加强术后随访。     

妊娠期宫颈上皮内瘤样病变的筛查及治疗

综述了妊娠期宫颈上皮内瘤样病变的筛查方法，强调保守性治疗，反复阴道镜检查及镜下活检是安全可靠的，追加醋酸白试验可增加过度诊断，但敏感性可大大提高，如果阴道镜检查排除宫颈浸润癌，妇产科医生可将治疗时间推迟至产后，母婴危险性将降低。LEEP（loop electrosurgical excision)治疗及宫颈锥切只应有于病理或阴道镜检查高度可疑癌或已证实为部症的孕妇，妊娠期CIN转归率较高，但必须严密随访。     

北京地区宫颈细胞学ASC-US患者的病理结果及其影响因素分析

目的:探讨北京地区宫颈细胞学筛查结果为未明确诊断意义的非典型鳞状上皮细胞(ASC-US)患者进一步检查后的病理结果及其影响因素。方法:2007-03-18-2008-09-26对北京12个区县25～54岁6339例已婚妇女进行了抽样调查,对宫颈细胞学检查结果为ASC-US的409例患者进行了进一步检查和分析。结果:6339例患者宫颈细胞学异常者607例(9.6%),其中ASC-US共409例(6.5%),占宫颈细胞学异常的67.4%。ASC-US/SIL为3.12。409例ASC-US阴道镜下组织活检结果显示炎症者172例(42.1%),宫颈上皮内瘤变(cervicalintraepithelialneoplasia,CIN)Ⅰ级者208例(50.9%),CINⅡ25例(6.1%),CINⅢ3例(0.7%),宫颈癌1例(0.2%)。404例患者(98.8%)接受人乳头瘤病毒(humanpapillomavirus,HPV)检测,显示HPV感染率为30.7%(124/404)。ASC-US患者是否感染HPV与CINⅠ的患病率差异无统计学意义,χ2=1.588,P=0.208;而HPV感染者CINⅡ以上的发生率明...     

电子阴道镜对宫颈上皮内瘤样病变的诊断初探

宫颈上皮内瘤样病变 (ＣＩＮ)是宫颈非浸润性癌前病变。早期发现ＣＩＮ是减少宫颈癌发病率的关键。我院于 1999年 12月以来对 4 62例患者进行阴道镜检查 ,现将结果报告如下。1　资料与方法1 1　一般资料　我院对 4 62例患者进行电子阴道镜检查 ,病例来源为妇科门诊及住院病人以及要求体检者 ,年龄 2 0～ 5 5岁 ,已婚或未婚有性生活史者。1 2　临床资料　对有性交后出血 ,白带多外阴瘙痒 ,妇科检查发现宫颈糜烂、宫颈息肉、宫颈潴留囊肿、宫颈赘生物及溃疡者以及要求体检者。1 3　方法　对 4 62例患者均采用日本ＳＬＬＫＡ电子阴道镜检查、检…     

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.     

阴道镜图像RCI评分早期诊断宫颈上皮内瘤样病变的临床价值

目的：探讨阴道镜Reid评分(RCI)在宫颈上皮内瘤样病变早期诊断中的临床意义。方法：对137例因阴道细胞学检查异常或宫颈窥视异常的宫颈病变患者行电子阴道镜检查，采用RCI评分评估宫颈病变，并在阴道镜指引下行宫颈多点活检，所得病理学结果与RCI评分进行对照分析。结果：采用RCI评分标准与组织病理结果的完全符合率为76．64％，包括相差一个级别在内者符合率为94．16％。结论：电子阴道镜用于宫颈病变诊断较为准确、可靠；RCI评分作为可量化指标可预示宫颈上皮内瘤样病变的严重程度，具有一定的临床意义。     

阴道镜检查在子宫颈上皮内瘤变及子宫颈癌诊断中的应用

 目的　探讨阴道镜检查在子宫颈疾病诊断中的应用价值。方法　对5833例受检者进行阴道脱落细胞液基薄层细胞学检查（TCT）及阴道镜检查,选取633例可疑有子宫颈病变者在阴道镜下行定点病理学检查。结果　633例子宫颈疾病患者中,阴道镜检查诊断为慢性子宫颈炎405例,子宫颈上皮内瘤变（CIN）183例（CINⅠ97例、CINⅡ48例、CINⅢ38例）,子宫颈癌45例。经病理学检查诊断为慢性子宫颈炎406例,CIN 180例（CINⅠ97例、CINⅡ46例、CINⅢ37例）,子宫颈癌47例。阴道镜检查对诊断CIN的灵敏度96.7 %（174／180）、特异度98.0 %（444／453）、准确度97.6 %（618／633）、阳性预测值95.1 %（174／183）,阴性预测值98.7 %（444／450）;子宫颈癌的灵敏度93.6 %（44／47）,特异度99.8 %（585／586）,准确度99.4 %（629／633）,阳性预测值97.4 %（44／45）,阴性预测值99.5 %（585／588）。 结论　阴道镜检查对诊断子宫颈疾病,尤其对诊断CIN和子宫颈癌有重要价值。     

Risk Factors for High-Grade Cervical Intraepithelial Neoplasia in Patients with Atypical Squamous Cells of Undetermined Significance (ASC-US) Papanicolaou Smears

Objective: To determine risk factors of high-grade cervical intraepithelial neoplasia (CIN 2-3) among womenwith atypical squamous cells of undetermined significance (ASC-US) Papanicolaou (Pap) smears. Methods: Twohundredand sixty-six women with ASC-US Pap tests who underwent a colposcopy with histologic study wereenrolled between August 2008 and June 2010. Patient data including age, education, income, parity, currentpills used, number of vaginal deliveries, number of sexual partners, age at first sexual intercourse, history ofsexually transmitted diseases, history of pelvic inflammatory disease and smoking habits were obtained. Logisticregression analysis was used to evaluate factors associated with CIN 2-3. Results: CIN was diagnosed in 134 of266 women (50.4%). Ninty-seven of these (72.4%) had CIN 1 and 37 (27.6%) had CIN 2-3. Frequency of thelatter was lower in women who had at least bachelor’s degree graduation as compared to those having less thanprimary school graduation (odds ratio (OR) 0.085, 95% confidence interval (CI) 0.013-0.557). In addition, thosewith a higher income (5,000-20,000 baht per month) had less frequent CIN 2-3 (OR 0.378, 95% CI 0.147-0.970),whereas women who had 3 or more sexual partners were more likely to develop CIN 2-3 (OR 3.181, 95% CI1.316-7.687). Conclusions: Women with ASC-US Pap smears who had 3 or more sexual partners, low educationand low income were at an increased risk of CIN 2-3. Therefore, this group of patients deserve a high priorityfor immediate colposcopy in order for early detection of high-grade CIN.     

Diagnostic Value of Endocervical Curettage for DetectingDysplastic Lesions in Women with Atypical Squamous Cells of Undetermined Significance (ASC-US) and Low Grade Squamous Intraepithelial Lesion (LSIL) Papanicolaou Smears

Background: To determine the frequency of dysplastic lesions in the endocervical curettage (ECC) specimensof women with ASC-US and LSIL Pap and to evaluate the possible factors associated with high grade dysplasia inthose ECC specimens. Materials and Methods: Two hundred and sixty patients with ASC-US and LSIL cytologicsmears who underwent an ECC at the time of colposcopic examination during January 2010 and December2012 were reviewed. Demographic and clinicopathologic data were collected. Multivariate analysis using binarylogistic regression was used to identify factors that might be associated with high grade endocervical dysplasia.Results: The frequency of endocervical dysplasia was 7.7% (20 out of 260 patients). Cervical intraepithelialneoplasia (CIN) 1 and CIN 2-3 lesions in the endocervical canal were observed in 12 and 8 patients, respectively.No microinvasive or invasive cervical cancers were identified. There was no difference in the frequency of highgrade endocervical dysplasia between the patients with satisfactory and unsatisfactory colposcopic examinations(1.4% vs 5.1%, respectively, p=0.087). A multivariate logistic regression analysis demonstrated a significantassociation between high grade CIN on ectocervical biopsy as well as LSIL cytologic smears and high gradedysplasia in endocervical canal (OR=0.046, 95%CI=0.007-0.288; p=0.001 and OR=0.154, 95%CI=0.025-0.942;p=0.043, respectively). Conclusions: The frequency of high grade endocervical dysplasia in women with ASC-USand LSIL cytologic smears was low. Therefore, routine performance of ECC in those women is debatable. Highgrade ectocervical dysplasia and LSIL cytologic smears may be used as predictors for high grade dysplasia inendocervical canal and ECC in these patients is reasonable.     

Clinical Significance of Atypical Squamous Cells of Undetermined Significance among Patients Undergoing Cervical Conization

Background: Atypical squamous cells of undetermined significance (ASCUS) feature a wide variety of cervical cells, including benign and malignant examples. The management of ASCUS is complicated. Guidelines for office gynecology in Japan recommend performing a high-risk human papillomavirus (HPV) test as a rule. The guidelines also recommend repeat cervical cytology after 6 and 12 months, or immediate colposcopy. The purpose of this study was to determine the clinical significance of ASCUS. Materials and Methods: Between January 2012 and December 2014, a total of 162 patients underwent cervical conization for cervical intraepithelial neoplasia grade 3 (CIN3), carcinoma in situ, squamous cell carcinoma, microinvasive squamous cell carcinoma, and adenocarcinoma in situ at our hospital. The results of cervical cytology prior to conization, the pathology after conization, and high-risk HPV testing were obtained from clinical records and analyzed retrospectively. Results: Based on cervical cytology, 31 (19.1%) of 162 patients were primarily diagnosed with ASCUS. Among these, 25 (80.6%) were positive for high-risk HPV, and the test results of the remaining 6 patients (19.4%) were uncertain. In the final pathological diagnosis after conization, 27 (87.1%) and 4 patients (12.9%) were diagnosed with CIN3 and carcinoma in situ, respectively. Conclusions: Although ASCUS is known as a low-risk abnormal cervical cytology, approximately 20% of patients who underwent cervical conization had ASCUS. The relationship between the cervical cytology of ASCUS and the final pathological results for CIN3 or invasive carcinoma should be investigated statistically. In cases of ASCUS, we recommend HPV tests or colposcopic examination rather than cytological follow-up, because of the risk of missing CIN3 or more advanced disease.     

The Association of Micronutrients with Plasma Squamous Cells of Undetermined Significance (ASCUS)

Little is known about factors that favor the development of cervical atypical squamous cells of undeterminedsignificance (ASCUS), nor how these factors might affect the pathogenesis of cervical neoplasia. The primary focusof this case-control study among the multiethnic population of Hawaii was to identify biomarkers of diet in therecent past that may influence the risk of ASCUS, after carefully accounting for the presence of HPV DNA. Casesincluded 185 women with ASCUS and 191 cytologically-normal controls diagnosed between 1992 and 1996 fromthree clinics in Honolulu, Hawaii. In-person interviews were conducted in the subjects’ homes, a fasting bloodsample was drawn to measure plasma levels of various micronutrients, and the presence and type of HPV wasdetermined in exfoliated cell samples using Polymerase Chain Reaction (PCR) dot blot hybridization.As results, we found an inverse dose-response gradient with increasing plasma concentrations of α-cryptoxanthinand δ-tocopherol for the development of ASCUS. The odds ratio for ASCUS among women in the highest quartilecompared with women in the lowest quartile of total cryptoxanthin was 0.5 (95% confidence interval (CI): 0.3-1.0),α-cryptoxanthin was 0.4 (0.2-0.8), total tocopherol was 0.5 (0.2-1.0), α-tocopherol was 0.5 (0.2-1.0), and δ-tocopherolwas 0.4 (0.2-0.8). Little association of plasma levels of lutein/zeaxanthin, lycopene, α- or β-carotene, retinol, vitaminC, or cholesterol, with disease risk was evident. Our findings suggest that women with high circulating concentrationsof cryptoxanthin and tocopherol may be at a reduced risk of ASCUS.     

HPV基因分型检测与非典型鳞状细胞的相关性研究

目的探讨人乳头瘤病毒（HPV）分型检测与难以确定的非典型鳞状上皮细胞（Asc-us）分流监测的相关性及其临床意义。方法对50例薄层液基细胞学（LCT）检查结果为Asc-us的病例,进行HPV基因扩增分型检测,所有病例均同时进行组织病理学检查。结果 50例Asc-us病例中HPV阳性23例,其中高危型17例。以组织病理学CINⅡ～CINⅢ级作为子宫颈高度病变判断标准,子宫颈高度病变在高危型HPV阳性组、低危型阳性组和全阴性组发生率分别为88.2%,66.6%和59.3%,差异有统计学意义（P〈0.05）。结论 HPV基因分型检测可靠准确,对LCT结果为Asc-us的病例进行快速筛查,能够有效进行分流监测,对降低子宫颈高度病变的漏诊率具有重要意义。     

Clinical Relevance of Atypical Squamous Cells of Undetermined Significance by the 2001 Bethesda System: Experience from a Cervical Cancer High Incidence Region

The aim of this study was to evaluate the underlying lesions and factors predicting cervical intraepithelialneoplasia (CIN) 2+ in women who had “atypical squamous cells of undetermined significance” (ASC-US) oncervical cytology in the region with a high incidence of cervical cancer. This study was prospectively conductedat Chiang Mai University Hospital, Chiang Mai, Thailand. All women with ASC-US cytology undergoingcolposcopic evaluation between October 2004 and August 2008 were recruited. During the study period, 208women were enrolled. Mean age was 44.4 years. The histopathologic results at the initial evaluation were asfollows: CIN 2-3, 21 (10.1%); adenocarcinoma in situ, 3 (1.4%); cancer, 5 (2.4%); CIN 1, 26 (12.5%); and nolesions, 153 (73.6%). Multivariate analysis revealed that nulliparity (adjusted odds ratio [aOR] =4.09; 95%confidence interval [CI] = 1.04-16.10) and current oral contraceptive use (aOR=2.85; 95%CI= 1.14-7.15) wereindependent predictors for having CIN 2+ at the initial colposcopy. At the median follow-up time of 6.7 months,CIN 2-3 lesions were additionally detected in 2 women. In conclusion, ASC-US cytology in our population has arelatively high prevalence of underlying invasive carcinoma. Nulliparity and current oral contraceptive use areindependent predictors for harboring CIN 2+.     

Risk of High-Grade Cervical Lesions in Atypical Squamous Cells of Undetermined Significance (ASC-US) Cytology: Comparison between HIV-Infected and HIV-Negative Women

Background and objective: Women with human immunodeficiency virus (HIV) infection have an increased risk of HPV infection, cervical neoplasia. This study was undertaken to compare the risk of having high-grade cervical lesions defined as cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in HIV-infected versus HIV-uninfected women who had atypical squamous cells of undetermined significance (ASC-US) on cervical cytology. Methods: Fifty-seven HIV-positive women aged 25-65 years with ASC-US cytology undergoing colposcopic examination between January 2008 and December 2020 at Chiang Mai University Hospital were reviewed. By matching 1:5 ratio, 285 HIV-negative women with ASC-US cytology in the same period were recruited as controlled subjects for comparison. The patient characteristics, HIV status, CD4 cell count within 6 months of colposcopy, antiretroviral therapy, parity, contraception, smoking history, number of sexual partners, and histopathology on cervical biopsy were analyzed. Results: Mean age ± SD of the HIV-positive and HIV-negative groups was 44.28 ± 8.53 years and 44.28 ± 9.68 years, respectively. HIV-positive women were significantly less likely to use contraceptive methods (36.8 % versus 48.8 % in HIV-negative women; P = 0.002). HIV-infected women significantly had more sexual partners than HIV-uninfected women. Both groups had similar risk for CIN 2+ (5.3 % in HIV-positive women compared with 4.9 % in HIV-negative women; odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.30 –3.87). After adjustment for no contraception use and number of sexual partners, the risk of CIN2+ in HIV-infected women remained unchanged; adjusted OR= 1.15, 95% CI = 0.27-4.92, P= 0.846). Conclusion: The risk of underlying high-grade cervical lesions in women with ASC-US on cervical cytology was approximately 5 %, regardless of HIV status.     

Colposcopic and Histological Outcome of Atypical Squamous Cells of Undetermined Significance and Atypical Squamous Cell of Undetermined Significance Cannot Exclude High-Grade in Women Screened for Cervical Cancer

Objectives: The objectives of the study are to assess the prevalence of colposcopic and histological abnormalities in patients diagnosed with ASCUS and ASC-H and to compare the prevalence of CIN in each group. Methods: Population-based cross-sectional retrospective study was conducted in one of tertiary hospitals in UAE. All cervical smears reported as ASCUS or ASC-H in 2015 were included in this study. The local guideline in 2015 was to refer all cases of ASC for colposcopy assessment. Results: Overall 7,418 cervical smears were processed at our laboratory service, 5.6% (n=413) were reported as ASC. 95% of them (n=394) were ASCUS and 5% (n=19) were ASC-H. The overall prevalence of high grade CIN in patients with ASC-H is 26% compared with 0.8% for patients with ASCUS regardless the age. The relative risk of patients with ASC-H is 8 folds higher than patients with ASCUS to have low grade CIN but 29 fold higher risk of having High grade CIN and the P value =0.0001.Conclusion: ASC-H cytology confers a substantially higher risk for high grade CIN than ASCUS regardless of age. HPV test is an important triage test in patients with ASCUS to predict cellular changes and CIN.     

宫颈不能明确意义的非典型鳞状细胞139例病理学分析

[目的]探讨宫颈细胞病理学检查TBS报告方式中诊断为不能明确意义的非典型鳞状细胞（ASC-US）形态学特点及其与组织病理学结果的关系。[方法]对139例宫颈ASC-US病例的细胞形态进行回顾性分析,总结其形态学特点,并结合其阴道镜下组织病理活检及HPV检测结果进行对比分析。[结果]139例ASC-US中细胞形态学特点可分为三类,包括不典型鳞化79例,不典型修复40例,不良角化20例。70例进行阴道镜下宫颈活检,发现CINⅡ1例,CINⅠ5例,宫颈扁平湿疣6例,宫颈黏膜慢性炎58例（不典型鳞化49例,不典型修复9例）;宫颈活检阳性的12例中不良角化型ASC-US11例。20例不良角化进行HPV检测,阳性16例,其中高危型9例,低危型7例。[结论]ASC-US的镜下形态学特点均可归入三类,其中不良角化型组织学活检结果、HPV检测阳性的比例最高,建议临床应对此型ASC-US进行活检及HPV检测,而其它两型应严格诊断标准。