液基细胞学检测和阴道镜在宫颈病变筛查中的应用研究

目的探讨液基细胞学检测（TCT）和电子阴道镜在子宫颈病变筛查中的诊断价值。方法对500例妇女行宫颈TCT和阴道镜检查，以活栓病理学诊断为佥标准，对宫颈癌和癌前病变进行筛查，并对结果进行分析。结果本组500例妇女中，阴道镜下定位活检病理诊断结果显示：宫颈上皮内瘤变-Ⅰ（CIN—I）39例、CIN-Ⅱ14例、CIN—Ⅲ例、宫颈癌8例。阴道镜发现异常83例，对上皮内瘤变诊断的敏感性93．51％．特异性为97．40％，漏诊率1．00％。宫颈TCT发现异常涂片60例，对CIN的诊断敏感性为58．44％，特异性为96．45％，漏诊率6．40％。联合宫颈TCT和电子阴道镜检查，诊断敏感性为96．10％，特异性为98．82％，漏诊率0．60％。结论阴道镜检查对宫颈癌及癌前病变的早期诊断价值优于宫颈TCT．联合宫颈TCT和阴道镜检查可进一步提高宫颈癌及癌前病变的检出率。

Clinical study of liquid based cytology test and colposcopy in primary screening for cervical lesions

Objective To investigate the clinical value of liquid based cytology test and colposcopy in the primary screening for cervical lesions, Methods Retrospective analysis was conducted in 500 females of the People＇s Hospital of Jianggan District admitted from January, 2007 to December, 2007. All the patients received liquid based cytology test and colposcopy in order to screen the cervical lesions. According to the pathological results, the clinical value of liquid based cytology test and colposcopy was analysed and compared. Results Among the 500 females, 39 cases were diagnosed as stage one cervical intraepithelial neoplasia （CIN- I ）, 14 cases as CIN-Ⅱ, 11 cases as CIN-Ⅲ, and 8 cases as cervical cancer by biopsy and pathological analysis. Simultaneity, 83 cases were determined as cervical intraepithelial neoplasia or cervical cancer by colposcopy, and 60 cases as atypical squamous cells of undetermined significance or above by liquid based cytology test. Among this group of patients, the sensitivity, the specificity and the rate of missing diagnosis of colposcopy in the diagnosis of CIN were respectively 93.51%, 97.40%, 1.00%, and these of liquid based cytology test were 58.44%, 96.45%, 6.40% respectively. Furthermore, the Sensitivity, the specificity and the rate of missing diagnosis were respectively 96.10%, 98.82%, 0.60% by the combination of colposcopy and liquid based cytology test. Conclusion In this clinical practice, colposcopy is more effective than liquid based cytology test in the primary screening for cervical lesions. Adjunctive liquid based cytology test can enhance the sensitivity and specificity of the diagnosis of cervical lesions by colposcopy.