宫颈巴氏涂片与LCT在低收入妇女妇科普查中的应用

目的探讨宫颈巴氏涂片与液基细胞学（LCT）在低收入已婚妇女宫颈癌筛查中的应用价值。方法2008年1月至6月上海市浦东新区妇幼保健院对所在社区6416例低收入已婚妇女（低收入组）采用宫颈巴氏涂片进行了宫颈癌筛查，其中322例同期行LCT，并与同期来上海市浦东新区妇幼保健院做宫颈癌筛查行LCT的294名妇女进行对照（对照组）。结果①宫颈刮片巴氏异常者（≥Ⅱb级）低收入组中22例（0．34％），其中Ⅱb级12例（0．19％），Ⅲ级10例（0．16％），无Ⅳ级及Ⅴ级。15例（Ⅱb5例，其余Ⅲ级）行阴道镜下活检，病理结果CIN8例，其中CIN12例，CIN2和CIN3各3例；②低收入组同期行LCT的322例妇女中，细胞学≥ASCUS共41／322例（12．73％），其中ASCUS15例，HSIL 1例，行阴道镜下活检病理结果CIN5例（CIN1和CIN2各2例，CIN31例）；HSIL1例为子宫颈鳞状细胞癌。对照组：细胞学≥ASCUS 22／294例（7．48％）。其中ASCUS 11例行阴道镜下活检。病理结果仅CIN 21例；2例LSIL；1例为CIN2。两组AGC各1例经阴道镜下活检均无异常；③低收入组中322例行宫颈刮片和LCT做自身对照：315例巴氏均为Ⅰ级，LCT正常；巴氏Ⅱb级2例，LCT均为ASCUS，病理分别为CIN1和CIN2；巴氏Ⅲ级3例，LCT检查，其中2例为ASCUS，阴道镜活检仅1例病理为CIN2。结论宫颈细胞学是筛查宫颈病变的有效手段，巴氏涂片法在基层对低收入人群仍可为主要筛查方法。有条件者可采用LCT，以提高宫颈疾病筛查的敏感性。

Evaluation of papanicolaou test and liquid-based cytology test in the cervical cancer screening for women in poverty

Objective To evaluate the cervical Papanicolaou （Pap） test and liquid- based cytology test （LCT） in the cervical cancer screening for married women in poverty. Methods From January to June 2008, 6 416 married women in poverty in Pudong received Pap test in Shanghai Pudong Women ＆ Children＇s Health Care Hospital. Among them, 322 women were sampled for LCT at the same time, as well as 294 non- poverty women who were sampled for LCT and recruited as the control group. Results ① In poverty group, 22 （0.34%） were found with abnormal Pap smear （≥grade Ⅱ b）, including 12 （0. 19%） of Pap lib and 10 （0. 16%） Pap Ⅲ. No Pap Ⅳ or Pap Ⅴ was found. In the 15 cases, 5 Pap Ⅱb and 10 Pap Ⅲ, received biopsy under colposcope, 2 with CIN1, 3 with CIN2 and 3 with CIN3 were pathologically diagnosed. ② In the 322 with both Pap test and LCT, 41 of them （12. 73%） were with cytology results of ≥ASCUS, including 15 of ASCUS and 1 of HSIL. After colposcopy with biopsy, 5 were pathologically confirmed with CIN （2 CIN1, 2 CIN2 and 1 CIN3） and the HSIL case was squamous cervical cancer. In the control group, 22/294 （7. 48%） were with cytology results of ≥ASCUS. One out of 11 women with ASCUS, who underwent biopsy and pathology examination after colposcopy, was CIN2. One out of the two LSIL was CIN2. Two cases with AGC in the two groups turned out normal. ③ In the 322 women with self-- controlled Pap test and LCT, 315 women were Pap Ⅰ and normal LCT. Two cases of Pap Ⅱb were both ASCUS of LCT; CIN1 and CIN3 for pathological results. Two out of the 3 women with Pap Ⅲ were ASCUS for LCT; and only one was CIN2 for pathological results. Conclusions Cervical cytological smear is effective for the cervical cancer screening. Pap test is essential methods in the primary health care level or resource limited area. LCT is recommended if it is permitted as a high sensitive method.