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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2012, Vol. 08 ›› Issue (01) : 21 -27. doi: 10.3877/cma.j.issn.1673-5250.2012.01.006

所属专题： 经典病例； 总编推荐； 文献；

论著

61 610例宫颈液基薄层细胞学检查的统计与分析
马爱国1,*,*(), 陆惠娟2   
  1. 1. 201206　上海，上海市浦东新区妇幼保健院病理科
    2. 同济医科大学附属上海第一妇婴医院
  • 收稿日期:2011-06-18 修回日期:2011-11-25 出版日期:2012-02-01
  • 通信作者: 马爱国

Liquid-Based Cervical Cytology for Cervical Cancer Screening: A Retrospective Analysis of 61610 Cases

Ai-guo MA1(), Hui-juan LU2   

  1. 1. Department of Pathology, Shanghai Pudong New Area Maternity and Infant Hospital, Shanghai 201206, China
  • Received:2011-06-18 Revised:2011-11-25 Published:2012-02-01
  • Corresponding author: Ai-guo MA
  • About author:
    Corresponding Author: MA Ai-guo, Email:
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马爱国, 陆惠娟. 61 610例宫颈液基薄层细胞学检查的统计与分析[J]. 中华妇幼临床医学杂志(电子版), 2012, 08(01): 21-27.

Ai-guo MA, Hui-juan LU. Liquid-Based Cervical Cytology for Cervical Cancer Screening: A Retrospective Analysis of 61610 Cases[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2012, 08(01): 21-27.

目的

探讨准确评价薄层液基细胞学检查(LCT)在宫颈癌筛查中的应用价值。

方法

回顾性分析2004年3月至2011年3月本院收集的61 610例标本的LCT结果，与阴道镜下多点组织活检结果进行对照研究，并与同期收集的128 554例传统巴氏涂片(Pap smears)检查结果进行对照分析。

结果

①61 610例LCT的复检结果为，未明确意义不典型鳞状细胞(ASCUS)及以上患者为1772例(2.88%，1772/61 610)，对其中1017例进行多点组织活检发现，38例(0.06%，38/61 610)为鳞状上皮细胞癌(SCC)及腺癌(GLCA)；251例(0.41%，251/61 610)为高级别鳞状上皮内病变(HSIL)[子宫上皮内瘤变(CIN) Ⅱ ～Ⅲ级分别为169例和82例]；409例(0.66%，409/61 610)为低级别鳞状上皮内病变(LSIL)(湿疣为216例，CIN Ⅰ级为193例)，腺上皮不典型增生(AGC)为5例，宫颈原位癌(AIS)为2例；慢性炎症为312例。同期进行巴氏涂片检查的128 554例标本中，共检出巴氏Ⅲ级及以上为272例(0.211%)，其中253例进行组织活检发现，65例为SCC和GLCA，97例为HSIL(CIN Ⅱ～Ⅲ级分别为40例和57例)，82例为LSIL(CIN Ⅰ级为45例、湿疣为37)，慢性炎症为9例。两种方法在筛查宫颈癌方面比较，差异无统计学意义(P>0.05)，但在筛查宫颈鳞状上皮病变(SIL)方面，LCT明显优于巴氏涂片，两者比较，差异有统计学意义(P<0.05)。②LCT诊断与组织学诊断的符合率分别为HSIL(82.77%，173/209)>SCC(73.53%，25/34)>LSIL(63.46 264/416)，LCT的假阳性主要来源于对LSIL的判定。

结论

LCT筛查CIN和宫颈癌较灵敏、可靠，明显优于传统巴氏涂片，特别是筛查高级别CIN，具有重大意义，但在筛查宫颈癌时，若存在因有效细胞数目过少、细胞重叠、炎症背景杂乱等因素，则可能造成漏诊或严重低诊，临床应引起重视。

关键词: 宫颈上皮内瘤变, 筛查, 薄层液基细胞学检查, TBS诊断系统, 巴氏涂片, 宫颈癌
Objective

To evaluate the value of liquid-based cytological test (LCT) as a screening method to detect cervical carcinoma.

Methods

The clinical data of 61 610 cases were collected from March 2004 to March 2011. The LCT results and colposcopic biopsy of 61 610 cases and 128 554 conventional Papnicoulau smears (CP) were compared and retrospectively analyzed. Follow-up diagnoses of colposcopic biopsy were available for those previously detected cytological abnormalities.

Results

① Among 61 610 LCT results, 1772 (2.88%) cases were cytological interpreted as atypical squamous cell of undetermined significance (ASCUS) or above, and among them, 1017 cases who received colposcopic biopsy showed 38 (0.06%, 38/61 610) were squamous cell carcinoma (SCC) or cervical adenocarcinoma (GLCA), 251 (0.41%, 284/61 610) were high grade squamous intraepithelial lesions (HSIL) [cervical intraepithelial neoplasia (CIN) Ⅱ, Ⅲ were 169 cases and 82 cases, respectively], 409 (0.66%, 399/61 610) were low grade squamous intraepithelial lesions (LSIL) (216 were condyloma and 193 were CIN I), atypical glandular cell (AGC) were 5 cases, adenocarcinomain situ (AIS) were 2 cases, and chronic inflammation were 312 cases. In the results of 128 554 specimen by CP, 272 cases (0.21%) were cytological interpreted as Pap Ⅲ or above. Among these 272 cases, 253 who received biopsy showed that 65 cases were cytological interpreted as SCC or GLCA, 97 were HSIL including 57 for CINⅡ and 40 for CINⅢ, 82 were LSIL including 45 for CINⅠ and 37 for condyloma, 9 were chronic inflammation. There was no significant difference between CP and LCT in detecting cervical carcinoma. ② The consistent rate of LCT and histological diagnosis was the follow: HSIL(82.77%, 173/209)>SCC(73.53%, 25/34)>LSIL(63.46%, 264/416).

Conclusions

Compared with CP, LCT has more sensitivity and reliability in screening for cervical carcinoma and SIL, especially in detecting HSIL. But we must pay more attention to the misdiagnosis or under-diagnosis of cervical carcinoma because of scant cellular, cell overlying, inflammation, etc. in the preparations.

Key words: cervical intraepithelial neoplasia, screening, liquid-based cytology test, the Bethesda System, pap smears, cervical cancer
表1 61 610例LCT标本的LCT初筛和复核结果比较[n(%)]
Table 1 Primary and re－review interpretation of 61 610 cases by liquid－based cytology test [n(%)]
TBS诊断结果 初筛率 复核后检出率
ASCUS 996(1.617) 749(1.220)
ASC－H 68(0.100) 36(0.060)
LSIL 780(1.279) 632(1.026)
? HPV感染 280(0.454) 195(0.317)
? CIN Ⅰ 354(0.575) 297(0.482)
? CIN Ⅰ合并HPV 155(0.252) 140(0.227)
HSIL 269(0.437) 237(0.385)
? CIN Ⅱ 180(0.292) 164(0.266)
? CIN Ⅲ 54(0.087) 40(0.065)
? HSIL合并HPV 35(0.057) 33(0.054)
AGC－NOS 75(0.122) 48(0.078)
AGC－倾向肿瘤 31(0.050) 29(0.047)
AIS 2(0.003) 2(0.003)
SCC 29(0.047) 37(0.060)
腺癌 1(0.002) 2(0.003)
合计 2250(3.652) 1772(2.876)
表2 1017例细胞学结果呈阳性患者的多点组织活检诊断结果
Table 2 Interpretation of cytology versus reference standard (histology diagnosis)
TBS诊断结果 多点组织活检诊断
Negative 湿疣 CIN Ⅰ CINⅡ CIN Ⅲ SCC AGC AIS GLCA 总计
ASCUS 148 58 39 11 1 0 0 0 0 257
ASC－H 10 1 3 11 7 2 0 0 2 36
湿疣 37 45 9 4 0 0 0 0 0 95
CIN Ⅰ 54 45 52 6 0 0 0 0 0 157
CIN Ⅰ合并湿疣 36 56 57 13 2 0 0 0 0 164
CIN Ⅱ 3 7 18 82 21 1 0 0 0 132
CIN Ⅲ 0 1 1 24 32 2 0 0 0 60
HSIL合并湿疣 0 1 1 9 5 1 0 0 0 17
SCC 0 0 0 2 10 25 0 0 0 37
AGC－NOS 18 1 13 4 0 0 4 0 0 40
AGC－倾向肿瘤 6 1 0 3 3 2 1 1 1 18
AIS 0 0 0 0 0 1 0 1 0 2
腺癌 0 0 0 0 1 0 0 0 1 2
合计 312 216 193 169 82 34 5 2 4 1017
表3 巴氏涂片诊断与多点组织活检结果对照
Table 3 Interpretation of conventional Pap smears versus reference standard (histology diagnosis)
巴氏分级 多点组织活检
Negative HPV CIN Ⅰ CINⅡ CIN Ⅲ SCC GLCA 总计
巴氏Ⅲ级 9 37 42 27 44 39 0 198
巴氏Ⅳ级 0 0 3 12 12 15 0 42
巴氏Ⅴ级 0 0 0 1 1 9 0 11
GLCA 0 0 0 0 0 0 2 2
合计 9 37 45 40 57 63 2 253
表4 两种方法检出鳞状上皮细胞内病变、鳞状上皮细胞癌及其组织学诊断的比较
Table 4 Detection of squamous intraepithelial lesion and squamous cell carcinoma by both cytological techniques versus reference standard (histology diagnosis)
方法 n 细胞学结果呈阳性 活检数 组织学结果
HSIL LSIL SCC＋GLCA
LCT 61 610 1772 1017 257 408 38
巴氏涂片 128 554 272 253 97 82 65
图4B 左图的组织学对照宫颈小细胞非角 化性鳞癌 (HE×100)
Figure 4B Follow up histology was invasive nonkeratinized small－sized squamous carcinoma of the cervix. (HE ×100)
图5B 左图的组织学对照 宫颈小细胞非角化性鳞癌 (HE×100)
Figure 5B Follow up histology of the patient of the left figure was invasive nonkeratinized small－sized squamous carcinoma of the cervix. (HE ×100)
图1B 左图的组织学对照 宫颈腺癌，病变较表浅，本例局灶原位腺癌 (HE×100)
Figure 1B Follow up histology the patient of the left figure was cervical superficial adenocarcinoma with foci AIS. (HE ×100)
图2B 左图的组织学对照(HE×100) 宫颈原位腺癌
Figure 2B Follow up histology of the patient of the left figure was AIS. (HE ×100)
图3B 左图的组织学对 照，宫颈黏液腺癌(HE×400)
Figure 3B Follow up histology of the patient of the left figure was invasive endocervical adenocarcinoma. (HE ×100)
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