液基细胞学检测筛查宫颈癌的应用评价

目的探讨液基细胞学检查（theThinPrepcytologytest,TCT）在宫颈早期病变诊断中的应用价值。方法对四川省妇幼保健院2009年7月至2011年5月门诊机会性筛查5164例妇女TCT结果与组织病理学检查结果进行对比分析。结果5164例TCT筛查中,细胞学阳性306例（5．93％）,其中意义不明的非典型鳞状上皮（atypical squamous cell of undetermined signification,ascus）163例（3．16％）,非典型鳞状上皮一不除外高度鳞状上皮内病变（atypical squamous cell,cannot excludehigh-grade squamousintraepitheliallesion,ASC—H）29例（0．56％）,低度鳞状上皮内病变（low—grade squarnous intraepithelial lesion,LSIL）101例（1．96％）,高度鳞状上皮内病变（high—grade squamous intraepitheliallesion,HSIL）11例（0．21％）,鳞状细胞癌（squamouscellcarcinoma,SCC）1例（0．02％）,非典型腺细胞,倾向肿瘤（atypicalglandularcell,favorneoplasia,AGC,VN）1例（0．02％）。TCT阳性结果与阴道镜下病理活检结果符合率：ASCUS为48．28％（42／87）,ASC—H为82．61％（19／23）,LSIL为56．00％（42／75）,HSIL为81．82％（9／11）,SCC为100．00％（1／1）,AGC,FN为0％（0／0）。结论TCT是筛查宫颈癌及癌前病变的重要手段和首选方法,且与组织病理学检查具有较高的符合率,有利于预防宫颈癌的发生。     

Evaluation of the efficacy and safety of 5-aminolevulinic acid-mediated photodynamic therapy in women with high-risk HPV persistent infection after cervical conization

ObjectiveTo evaluate the efficacy and safety of photodynamic therapy (PDT) in women with high-risk human papillomavirus (hr-HPV) persistent infection after cervical conization, including loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC).Materials and methodsThe clinicopathological and follow-up data of 76 women with hr-HPV persistent infection after cervical conization (54 cases with LEEP and 22 cases with CKC) were collected. All the women in this group met these criteria: postoperative pathological diagnosis of LEEP/CKC showed high grade squamous intraepithelial lesions (HSIL) with negative incisal margin, hr-HPV persistent infection after LEEP/CKC ≥ 1 year, colposcopy and histopathology showed no intraepithelial lesions before PDT, and 5-aminolaevulinic acid (5-ALA) as photosensitizer treating for 6 times with an interval of 7-10 days. The above patients were followed up 6 months and 12 months after PDT, and the follow-up contents included Roche Cobas HPV classification test, cytology, colposcopy, and pathological examinations. HPV negative conversion rate is an index to evaluate the efficacy of PDT. In addition, we also assessed the safety of PDT.ResultsSix months after PDT, the overall HPV clearance rate was 59.21% (45/76). The HPV negative conversion rates in patients ≤ 50 years old group and > 50 years old group were 68.52% (37/54) and 36.36% (8/22), respectively (P=0.009). But there was no significant difference in HPV clearance rate between the HPV16/18 infection group and other hr-HPV infection group (P=0.3326). 12 months after PDT, 1 case underwent hysterectomy because of progression to HSIL, and 7 cases lost follow-up. The overall HPV clearance rate was 88.24% (60/68). The negative conversion rates of HPV16/18 and other hr-HPV infection groups were 76.00% (19/25) and 95.35% (41/43), respectively (P=0.0458). However, the HPV negative conversion rate was not correlated with the patient's age (P=0.2383). The adverse reactions after PDT were mild, mainly manifested as increased vaginal secretions or burning/tingling.ConclusionsPhotodynamic therapy could be an effective treatment for patients with hr-HPV persistent infection after cervical conization and it could promote the negative conversion of hr-HPV and prevent the recurrence progression of cervical intraepithelial neoplasia (CIN) after LEEP/CKC.     

Comparison of the sensitivity of conventional cytology and the ThinPrep Imaging System for 1,083 biopsy confirmed high‐grade squamous lesions

Liquid‐based cytology continues to be utilized as an adjunct to conventional cytology in most Australian laboratories, even though a direct‐to‐vial ThinPrep protocol has been introduced in many countries with established cervical screening programs. Manual screening of ThinPrep slides has been widely practiced for more than 10 years and the recent introduction of the ThinPrep Imaging System (TPI) has been reported as being more sensitive than the conventional smear (CS) in the identification of high‐grade cervical disease. We report our experience with ThinPrep Imaging since its introduction into our routine gynecological cytology service. 87,284 split sample pairs reported using the Imaging System demonstrated a decrease in unsatisfactory reports (3.65% for CS and 0.87% for TPI) and an increase in possible high grade and definite high‐grade squamous reports (1.57% for CS and 1.62% for TPI). For 1,083 biopsy confirmed high‐grade lesions, the correct diagnosis of high grade or possible high‐grade squamous disease was made on the ThinPrep imaged slide in 61.0% (661/1,083) of cases and on the CS in 59.4% (643/1,083). This was not statistically significant. When all abnormalities identified on cytology were considered, including possible low grade and definite low‐grade abnormalities, the difference in sensitivity for Thinprep imaged slides of 96.0% (1,040/1,083) and CSs of 91.6% (992/1,083) was statistically significant. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Comparison of the clinical significance of the Papanicolaou test interpretations LSIL cannot rule out HSIL and ASC‐H

Despite the two‐tiered classification of dysplasia in The Bethesda System (TBS), rare cases fall into the category squamous intraepithelial lesion (SIL) of indeterminate grade. These Pap tests are often interpreted as “LSIL/ASC‐H” or “LSIL” with a comment indicating the presence of cells with features approaching HSIL. Patients with LSIL/ASC‐H have a significant risk of CIN 2 or worse (29–61.5%) on follow‐up cervical biopsies, similar to the risk of CIN 2 or worse in patients with ASC‐H Pap tests (24–68%). The purpose of this study was to compare patients with ASC‐H and LSIL/ASC‐H Pap tests. Women with LSIL/ASC‐H had a slightly lower incidence of CIN 2 or worse (PPV = 35.6%, 95% CI: 29.8–41.4%) on follow‐up cervical biopsy than the control ASC‐H group (PPV = 40.2%, 95% CI: 31.9–56.3%); this difference was not statistically significant. The difference in the distribution of the biopsy results between the two groups was statistically significant (P < 0.001). The current guidelines for the management of cervical cytologic abnormalities from the American Society for Colposcopy and Cervical Pathology (ASCCP) advocate similar treatment algorithms for both LSIL and ASC‐H. The main difference is the option of cytologic follow‐up or HPV testing for certain “special populations,” as an alternative to colposcopy, for LSIL Pap test results. Based on our results, we recommend (1)LSIL/ASC‐H to be added to TBS classification and (2) Pap test cases of LSIL/ASC‐H may need to be clinically followed in a manner similar to ASC‐H, i.e., colposcopy for all patients. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

人乳头瘤病毒辅助细胞学筛查宫颈癌

目的 探讨人乳头瘤病毒(HPV)作为宫颈癌细胞学筛查辅助手段的作用。方法 用薄层液基细胞涂片法进行宫颈细胞学检查,用第二代杂交捕获试验检测所有细胞学异常患的13种高危型HPV DNA。细胞学检测为非典型鳞状细胞、HPV检测阳性,以及低度鳞状上皮内病变,高度鳞状上皮内病变,鳞状细胞癌等细胞学异常行阴道镜下活组织病理检查。分析HPV感染与宫颈癌及宫颈上皮内瘤变的关系,与细胞学检测细胞异常的关系。结果 HPV DNA检出率随宫颈病变程度加重呈趋势性增高。非典型鳞状细胞中31．4％HPV检测阳性,HPV阳性的非典型鳞状细胞宫颈上皮内瘤变及更严重病变占51．1．％。结论 HPV DNA检测作为宫颈癌细胞学筛查的辅助手段,最清楚的作用是提高诊断精确率,减少细胞学检查结果为交界或轻度异常患不必要的阴道镜检查。高危型HPV检测可指导早期HPV感染的治疗及患的追踪随访。     

Atrophic vaginitis versus invasive squamous cell carcinoma on ThinPrep® cytology: Can the background be reliably distinguished?

The presence of pronounced squamous epithelial atrophy/atrophic vaginitis on cervicovaginal preparations can present diagnostic difficulties, particularly in the presence of a granular background. The purpose of this study was to compare and contrast the background material present on ThinPrep cytology in cases of atrophic vaginitis and invasive squamous cell carcinoma (SCC). Thirty-three cases of atrophic vaginitis showed a heavy background of granular material containing acute inflammatory cells, apoptotic bodies, and fresh/crenated red blood cells. These findings were indistinguishable from those present in five cases of invasive SCC. The only significant finding was the presence of malignant squamous epithelial cells in the latter. Since the background material in pronounced squamous epithelial atrophy/atrophic vaginitis mimics that present in invasive SCC on ThinPrep cytology, close attention must be paid to the cells present on the slide in order to render an accurate diagnosis.     

A simple method to determine the need for glacial acetic acid treatment of bloody ThinPrep Pap tests before slide processing

ThinPrep (TP) Papanicolaou (Pap) samples containing excessive blood often result in unsatisfactory preparations, possibly leading to undetected gynecologic disease, and added inconvenience to patients and clinicians. Reprocessing of these samples with a glacial acetic acid wash is effective at eliminating blood, providing satisfactory preparation and detection of lesions. However, it increases laboratory costs and decreases work flow efficiency. We report the use of a color standard for gauging the necessity of performing a glacial acetic acid wash before TP processing. This "preprocessing" was found to reduce the costs associated with reprocessing by 48%, while maintaining high preparation quality by improved sample adequacy.     

Comparison of ThinPrep and conventional preparations: Nongynecologic cytology evaluation

ThinPrep processing, an automated cytopreparatory method, has been reported to show good correlation with conventional preparations and to reduce the rate of false-negative diagnoses. In a retrospective review of 230 consecutive nongynecologic cytology cases, we compare the ThinPrep (TP) method with conventional preparations (CP). There were 129 fine-needle aspiration (FNA) specimens from various sites, including 51 breasts, 40 thyroids, 14 lungs, 8 livers, and 16 miscellaneous sites. The sources of 101 body cavity fluids included 68 pleural peritoneal effusions, 25 peritoneal pelvic washings, and 8 miscellaneous sites. Each case was evaluated for cellularity, morphologic details, and obscuring background material. Diagnoses of the TP slides were classified as insufficient, normal, benign, suspicious, or malignant. Each case was then correlated with the tissue diagnosis when available. In TP slides, cellular arrangements, nuclear details, and nuclear cytoplasmic ratio were preserved, while blood and diathesis were eliminated. There was no statistically significant difference between TP and CP in the diagnostic categories. However, in six cases of “insufficient for diagnosis” on FNA by CP. TP yielded sufficient cells and tissue fragments for diagnosis. One case each of FNA and body fluid with a diagnosis of “suspicious for malignancy” by CP was considered “positive” on TP slides. The overall sensitivity of TP was 97.6%, and the specificity was 92.9%. The positive predictive value was 93.0%. We conclude that the ThinPrep method shows good correlation with conventional preparations in both FNA and body fluids. Diagn. Cytopathol. 16:368–371, 1997. © 1997 Wiley-Liss, Inc.     

液基薄层细胞检测诊断宫颈病变的临床研究

目的探讨液基薄层细胞检测（TCT）在筛查和诊断宫颈疾病方面的价值。方法对330例患者同时行巴氏涂片法与TCT法宫颈细胞学检测,对81例细胞学检测阳性（ASCUS／ASGUS及以上）者进一步行阴道镜下宫颈活组织检查,观察比较其检测阳性率及准确度。结果TCT法对异常细胞的阳性检出率明显高于巴氏涂片法（23．94％vs 16．06％,P〈0．05）,对重度细胞病变（LSIL及以上）的检出率提高42．92％。以阴道镜下宫颈活检为金标准,TCT法的阳性符合率显著高于巴氏涂片法（67．09％vs 45．28％,P〈0．05）。结论与巴氏涂片法相比,应用TCT法筛查宫颈病变具有更高的敏感性TCT法联合阴道镜下活检能提高宫颈癌前病变的诊断准确率。