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目的 对子宫颈癌和癌前病变的检查方法进行综合分析比较与评价。方法 对 2 10 0例患者分别采用传统宫颈细胞涂片 (10 4 9例 )和新柏氏薄层细胞学检测系统 (Thinprepcytologictest,TCT 10 5 1例 )进行宫颈病变的早期筛查 ,对 2 0 6例细胞学阳性或临床可疑的患者行阴道镜下活组织检查。结果 TCT标本的不满意率(0 .4 8% )明显低于传统宫颈细胞涂片 (1 4 3% ) ,明显提高了子宫颈癌及癌前病变的阳性诊断率 ,降低了对AS CUS的诊断率。传统细胞学和TCT检查与阴道镜下活检病理结果符合率分别为LSIL :5 6 82 % (2 5 4 4 )和 74 36 %(2 9 39) ,HIS :4 5 4 5 % (5 11)和 85 71% (18 2 1) ,HPV感染的符合率分别为 5 3 5 7% (15 2 8)和 75 6 8% (2 8 37)。HPV感染和CIN的高发年龄分别为 2 0～ 30岁和 30～ 5 0岁。结论 宫颈细胞学筛查是子宫颈癌及癌前病变早期诊断的重要手段 ,TCT独特的取材与制片方法 ,更有利于宫颈阳性病变的检出 ;细胞学筛查异常或临床可疑的患者 ,应在阴道镜下多点活检 ;细胞学提示HPV感染者 ,应行病理和HPV -DNA检测证实。
Objective To comprehensively compare and evaluate the methods of examining cervical cancer and precancerous lesions. Methods Early screening of cervical lesions was performed in 210 cases of patients with cervical smears (1049 cases) and Thinprep cytology test (TCT 1051 cases) Cases of cytology-positive or clinically suspicious patients colposcopy biopsy. Results The unsatisfactory rate (0.48%) of TCT specimens was significantly lower than that of traditional cervical smears (14.3%), which significantly improved the positive rate of cervical cancer and precancerous lesions and decreased the rate of AS CUS Diagnostic rate. The coincidence rates of traditional cytology, colposcopy and colposcopic biopsy results were LSIL: 56.282% (2 544) and 74 36% (29 39), HIS 45.55% (511) And 85 71% (18 2 1) respectively. The coincidence rates of HPV infection were 53 7% (15 2 8) and 75 6 8% (2 8 37), respectively. The high incidence of HPV infection and CIN were 20 to 30 years old and 30 to 50 years old. Conclusion Cervical cytology screening is an important method for early diagnosis of cervical cancer and precancerous lesions. TCT unique method of extraction and preparation is more conducive to the detection of positive cervical lesions; abnormal cytological screening or clinical suspicious patients, Colposcopy should be more biopsy; cytology prompted HPV infection should be confirmed by pathology and HPV-DNA test.