宫颈上皮内瘤变及早期癌细胞学的筛查

目的应用TBS分折系统探讨在改良的宫颈涂片上诊断宫颈上皮内瘤变及早期癌的准确性及临床特点。方法对7630例宫颈涂片细胞学筛查阳性(即非典型细胞以上的病变)551例及阴性550例同时以组织学检查为标准作对照分析,两项检查均双盲进行。结果细胞学鳞状上皮内高度病变与组织学活检的CINⅡ~CINⅢ检出率为71.43%,其准确率为67.00%;早期鳞状细胞癌检出率为87.50%,其准确率为81.50%;细胞学的假阴性率为6.36%,而高度病变的CINⅡ假阴性率为6.12%;早期癌及高度病变的CINⅢ未见假阴性结果,明显低于常规巴氏涂片法的文献报告。HPV感染与CIN的发生发展关系密切,且宫颈癌病变呈年轻化。结论采用此方法广泛开展宫颈细胞学筛查,特别在贫困地区,有利于及时发现宫颈病变,尤其是高度病变及早期癌。细胞学筛查阳性的病人应及时作宫颈组织学检查,进一步明确诊断,提高CIN及HPV感染的诊断率,将对宫颈癌的早期发现、早期诊断、早期预防起到重要作用。

Cytologic screening for cervical intraepithelial lesion and early stage carcinoma

Objective:To evaluate the accuracy and clinical characteristics of the cytodiagnosis for cervical intraepithelial lesion and early stage carcinoma with TBS system.Methods:551 of 7630 cases in cervical cytologic screening abnormality and 550 of those negative were diagnosed by histology. The results of cytologic screening compared with the “standard” results of histogic diagnosis was analysed. Both tests were carried out independently and blindly.Results:The rate of the able detect for cytologic high grade squamous intraepithelial lesion(HSIL) and histologic CIN Ⅱ～Ⅲ was 71.43%, the rate of accuracy was 67.00%.The rate of the able detect both the cytology and histology of early stage of the squamous cell carcinoma was 87.50%, the rate of accuracy was 81.50%.The false negative rate of cytology was 6.36%, CINII of the HSIL was 6.12%. The CINIII of the HSIL and the early stage of carcinoma was not false negative. These were levels lower than the document reports with routine medthod. This HPV infection concerned the CIN development deeply in youngster and made the age of cervical carcinoma younger in average.Conclusion:Use this method to practise extensively cervical cytologic screening especially in poverty areas is benefical to detect the cervical lesion in time. HGSL and early stage carcinoma are so. The histologic test should be given for cytologic abnormality so that the case is defined for further pathologic diagnosis, CIN and HPV infection are found further out and are treated in time, The lesion devlopment is impeded, which will play a positive role in early finding and diagnosing and preventing cervical carcinoma.