液基薄层细胞检测系统与阴道镜下活检在诊断子宫颈病变中的价值

目的 探讨液基薄层细胞检测系统（TCT）宫颈细胞涂片及阴道镜下宫颈活检对宫颈上皮内瘤变（CIN）的诊断价值。方法 回顾性分析哈尔滨医科大学附属肿瘤医院4041例TCT筛查结果及其中308例细胞学阳性行阴道镜下活检的病理结果。结果 鳞状上皮内低度病变（LSIL）及鳞状上皮内高度病变（HSIL）的诊断，细胞学检查诊断率高于阴道镜下活检病理学检查。炎症及鳞状细胞癌（SCC）的诊断，阴道镜下活检病理学检查诊断率高于细胞学检查。结论 采用TCT筛查可早期发现宫颈病变；细胞学阳性或临床可疑者应配合阴道镜捡查及镜下活检可提高CIN的检出率；对TCT呈意义不明确的非典型鳞状细胞（ASC-US）和不除外高度上皮内瘤变的非典型鳞状细胞（ASC-H）的患者进行阴道镜下活检可降低漏诊率。

Value of thin prep cytologic test and cervical biopsy punched under the instruction of colposcopy to the cervical lesion

[Objective] To study the diagnoses value of cervical cell smear produced by fluid based thin-layer cytological test system (TCT) and cervical biopsy punched under the instruction of colposcopy to the cervical intraepithelial neoplasia(CIN). [Methods] Retrospective analyze clinical information of 4 041 patients received TCT at Gynecologic Department of the Affiliated Tumour Hospital of Harbin medical university and 308 patients who received multiple punch biopsies because of abnormal cervical cytological specimen or high-grade clinical suspicion. [Results] The diagnosis rate of Low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) determined by TCT were evidently higher than that by pathologic examination. The diagnosis rate of inflammation and squamous cell carcinoma (SCC) determined by pathologic examination were evidently higher than that of by TCT. [Conclusions] It may detect cervical lesion in its early stage if fluid based thin-layer cytological test is adopted; The patients whose cytological test are positive or clinical high-grade suspicious should receive directed punch biopsy under colposcopy. These tests may benefit to increase detection rate of CIN and HPV infection; The patients whose TCT smear diagnoses is ASCUS or ASC-H should accept biopsy under the colposcopy, this may decrease the misdiagonises rate of CIN.