宫颈细胞学检查为ASCUS的临床意义及处理探讨

目的:探讨宫颈细胞学检查为ASCUS(不典型鳞状细胞-意义不明)的临床意义和处理方法。方法:2005年3月至2007年9月,对上海市第十人民医院妇科就诊的218例细胞学检查报告为ASCUS患者行阴道镜评估与镜下活检,其中100例患者同时进行了高危HPV-DNA检测。结果:218例ASCUS患者中宫颈上皮内瘤变(CIN)的发生率为49.54%,高级别CIN及浸润癌的发生率为17.43%,阴道镜拟诊≥CINⅡ40例,与病理结果相符29例,符合率72.5%(29/40)。高危HPV阳性组CIN检出率为66.67%,明显高于阴性组的36.96%。高级别CIN(CINⅡ、CINⅢ)17例中16例高危HPV-DNA检测阳性,仅1例CINⅡ为阴性。鳞癌3例,高危HPV检测均为阳性。结论:细胞学报告为AS-CUS时,阴道镜下病理活检结果相差大,而且可能是发现高度CIN的第一个信号,需引起重视。高危HPV-DNA检测是一种有效的ASCUS分流管理手段,能提高CIN的检出率。

Clinic significance and management strategy with atypical squamous cells of undetermined significance

Objective：To analysis the clinic significance of atypical squamous cell of undetermined significance （ASCUS）and to assess the value of HPV testing in detection of highgrade CIN. Methods：During March 2005 to September 2007 ,a total of 218 women in our department were diagnosed with ASCUS by cytological test,they were further biopsied under the colposcope, 100 cases of them were combined by high-risk HPV-DNA testing. Results： Among patients investigated, 108 patients were diagnosed with CIN. Comparing the colposcopic rusult with biopsied result,the consensus rate was 72.5% in high grade CIN and SCC. The detection rate of CIN in HPV positive ann was obviously higher than that of negative ann. In 17 cases of CINII and CIN m,16 cases were high-risk HPV positive. Conclusion： Minimally abnormal Pap smears-ASCUS reveal histologic findings ranging from normal to invasive carcinoma, and it may be the first indication of HSIL. HPV testing is a viable option in the management of women with ASCUS.