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

doi:10.3877/cma.j.issn.1673-5250.2012.01.006

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
TBS诊断结果	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
TBS诊断结果	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
巴氏分级	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
巴氏分级	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
方法	n	细胞学结果呈阳性	活检数	HSIL	LSIL	SCC＋GLCA
LCT	61 610	1772	1017	257	408	38
巴氏涂片	128 554	272	253	97	82	65

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
方法	n	细胞学结果呈阳性	活检数	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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