宫颈细胞检查为非典型鳞状上皮细胞的临床意义及分流管理的探讨

目的:探讨宫颈细胞检查为不典型鳞状上皮细胞在宫颈病变中的临床意义,为临床提供指导和管理依据。方法:对402例细胞学检查为ASC的患者行阴道镜检查及定位活检,其中202例患者同时进行了高危HPV-DNA检测。结果:20～39岁患者高级别CIN(CINⅡ～CINⅢ)的发生率明显高于其他年龄组(P0.05)。ASC包含各级别宫颈病变,CIN的发生率为40.02%,高级别CIN(CINⅡ～CINⅢ)及浸润癌的发生率为9.70%,阴道镜诊断与病理学结果有较高一致性,Kappa=0.7(P0.001)。高危型HPV-DNA阳性组CIN检出率为78.38%,明显高于阴性组的17.19%(P0.05),高级别CIN(CINⅡ～CINⅢ)27例中26例HPV-DNA检测为阳性,鳞癌1例,HPV-DNA检测为阳性。结论:ASC中有较高的宫颈病变发生率,阴道镜检查对宫颈病变诊断有较高的预测价值,可以指导ASC的分流管理。高危HPV-DNA检测是有效的辅助诊断技术。

Clinical significance and exploration on scattered management of atypical squamous cell diagnosed by cervical cytological examination

Objective:To explore the clinical significance of atypical squamous cell(ASC)diagnosed by cervical cytological examination in cervical lesions,and provide a basis for guidance and management.Methods:402 cases with ASC diagnosed by cervical cytological examination underwent colposcopy examination and localized biopsy,and 202 cases of them underwent high risk HPV-DNA test.Results:The incidence of CIN Ⅱ～CIN Ⅲ in cases aged 20~39 years old was significantly higher than those in the other age groups(P<0.05).ASC included different degrees of cervical lesions,the incidence of CIN was 40.02%,the incidence of CIN Ⅱ～CIN Ⅲ and invasive cervical carcinoma was 9.70%,the diagnostic results of colposcopy was consistent with the diagnostic results of pathological examination,Kappa=0.7(P<0.001).The detection rate of CIN in HPV-DNA positive group was 78.38%,which was significantly higher than that in HPV-DNA negative group(17.19%)(P<0.05),among 27 cases of CIN Ⅱ～CIN Ⅲ,26 cases were found with positive HPV-DNA,one case with positive HPV-DNA was diagnosed as cervical squamous cell carcinoma.Conclusion:Among cases of ASC,the incidence of cervical lesions is high,colposcopy examination plays an important role in diagnosis of cervical lesions,which can direct scattered management of ASC.High risk HPV-DNA test is an effective aided diagnosis technique.