传统宫颈细胞学检查与薄层细胞学检测的分析比较与评价

目的　对子宫颈癌和癌前病变的检查方法进行综合分析比较与评价。方法　对 2 10 0例患者分别采用传统宫颈细胞涂片 (10 4 9例 )和新柏氏薄层细胞学检测系统 (Thinprepcytologictest,TCT 10 5 1例 )进行宫颈病变的早期筛查 ,对 2 0 6例细胞学阳性或临床可疑的患者行阴道镜下活组织检查。结果　TCT标本的不满意率(0 .4 8% )明显低于传统宫颈细胞涂片 (1 4 3% ) ,明显提高了子宫颈癌及癌前病变的阳性诊断率 ,降低了对AS CUS的诊断率。传统细胞学和TCT检查与阴道镜下活检病理结果符合率分别为LSIL :5 6 82 % (2 5 4 4 )和 74 36 %(2 9 39) ,HIS :4 5 4 5 % (5 11)和 85 71% (18 2 1) ,HPV感染的符合率分别为 5 3 5 7% (15 2 8)和 75 6 8% (2 8 37)。HPV感染和CIN的高发年龄分别为 2 0～ 30岁和 30～ 5 0岁。结论　宫颈细胞学筛查是子宫颈癌及癌前病变早期诊断的重要手段 ,TCT独特的取材与制片方法 ,更有利于宫颈阳性病变的检出 ;细胞学筛查异常或临床可疑的患者 ,应在阴道镜下多点活检 ;细胞学提示HPV感染者 ,应行病理和HPV -DNA检测证实。

Comparison and evaluation of the screen methods of cervical cancer and cervical intraepithelial neoplasm

Objective To evaluate cytological screen methods of cervical cancer and precancerous lesion. Methods A total of 1 049 and 1 051 women underwent classical cervical smears and Thinprep cytological test(TCT)respectively.206 cases with abnormal cervical cytological results received colposcopic exa mination and multiple biopsy.The cytological results were compared with pathologic exa mination. Results Unsatisfied samples and cases with atypical squamous cell of undeter mined significance(ASCUS)of TCT was significantly less than classical cervical smears.The positive rates of cervical carcinoma and cervical intraepithelial neoplasm(CIN)of TCT were higher than classical cervical smears.The coincidences of classical cervical smears and TCT screening with histologic-colposcopic results were as follow:LSIL 56.82%(25/44)and 74.36%(29/39), HSIL 45.45%(5/11)and 85.71%(18/21), HPV infection 53.51%(15/28)and 75.68%(28/37).The high incidences of HPV infection and CIN were found among women in twenties and from 30 to 50 years old, respectively. Conclusions TCT is more propitious to screen cervical cancer and precancerous lesion.Cases with abnormal cytology and HPV infection should received cervical multiple biopsies under guidance of colposcopy for pathological exa mination and HPV-DNA test.