对宫颈细胞学诊断意义未明的不典型鳞状细胞患者的临床管理

目的评价3种临床处理方案对宫颈细胞病理学意义未明的不典型鳞状细胞（ASC—US）患者的临床价值。方法遵循2001年TBS系统和美国阴道镜与子宫颈病理学会（ASCCP）提出的诊治规范,评价3种临床处理方案的价值。将宫颈细胞病理学（液基薄层）诊断的ASC—US1394例,分3组进行3种临床方案的处理的评价;以组织病理学结果≥高度鳞状上皮内病变（HSIL）,即≥宫颈上皮内瘤样病变Ⅱ（CIN2）的百分率为标准进行评价。A组：421例,直接阴道镜检查＋活检术／颈管刮术（ECC）;B组：475例,6个月后随诊,重复细胞病理学检查结果≥ASC—H或ASC—US同时HPV—DNA阳性者,行阴道镜检查＋活检术／ECC。C组：498例,行HPV—DNA检测。将HPV—DNA阳性者,分成≥30岁,〈30岁两组,分别行阴道镜检查＋活检术／ECC。结果组织病理学≥CIN2者,A组27例（6．41％）,B组26例（5．78％）,C组34例（6．91％）,3组差异无统计学意义（P〉0．05）。3组易行性比较,差异有统计学意义（P〈0．01）,即A组工作量大,患者有不适感;B组等待时间长,依从性差。在费用上,C组较贵（P〈0．01）。在C组中,ASC—US同时HPV—DNA阳性者,年龄≥30岁者占66％,年龄者〈30岁占34％。组织病理学≥CIN2,前者占5．69％,后者占1．22％。结论方案B和C临床较实用。因为宫颈癌病因是HPV感染,如经济条件允许,应首选C方案,即ASC—US的患者同时行HPV—DNA检测。在ASC—US中,30岁以上的HPV阳性者为筛查的高危人群。

Evaluation of clinical management strategies for atypical squamous cells of undetermined significance in cervical cytology

OBJECTIVE: To evaluate the 3 different clinical management strategies for patients with cervical cytological atypical squamous cells of undetermined significance (ASC-US) recommended by the guideline of The 2001 Bethesda system and the 2001 American Society for Colposcopy and Cervical Pathology (ASCCP). METHODS: 1394 patients with a cytopathological diagnosis of ASC-US by use of liquid-based thin-layer preparation were managed by three different clinical strategies, and evaluated by the percentage of histological diagnosis > or = high-grade intraepithelial lesion (HSIL), i.e., cervical intraepithelial neoplasia (CIN2 and 3) as standard. 421 patients in Group A underwent colposcopically directed cervical biopsy, 475 patients in Group B were followed-up after 6 months by cytology, colposcopy and biopsy were performed if the results were > or = ASC-H or ASC-US and HPV-DNA (+). 498 patients in Group C: underwent HC-II test, colposcopy and biopsy were performed on those aged > or = 30 and with the HPV-DNA (+), if the patients were aged < 30 and with the HPV-DNA (+), HC-II test and cytology would be performed after 6 months; colposcopy and biopsy were performed on those with the results > or = ASC-H or HPV-DNA (+). RESULTS: (1) The results of histological diagnosis > or = CIN2 were found in 27 cases (6.41%) of Group A, 26 cases (5.78%) of Group B, and 34 cases (6.91%) of Group C. There was no statistically significant difference among these 3 groups (all P > 0.05). (2) Convenience was significantly different among these 3 groups (P < 0.01). The workloads for the doctors and the discomfort resulting from biopsy for the patients were the greatest in Group A. The patient's compliance of Group B was low because of the necessity to wait for follow-up six months later. The cost of Group C was relatively higher. (3) In Group C, 66% of the ASC-US patients with HPV-DNA (+) were aged > or = 30. The percentage of histological diagnosis > or = CIN2 was 5.69% in those aged > or = 30 and was 1.22% in those aged < 30. CONCLUSION: Both protocols B and C are practical for clinical management of ASC-US in China. HPV infection is the necessary cause of cervical carcinoma, so the protocol C (cytology and HC-II test) is better for cervical lesion screening. The ASC-US patients aged > or = 30 and with HPV-DNA (+) are at high risk.