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目的:探讨宫颈液基薄层细胞学检测(LCT)假阴性结果产生的原因。方法:回顾性对比分析2006~2009年因各种指征行阴道镜检查患者的LCT结果与镜下活检病理诊断。结果:①1 859例行阴道镜检查患者中,有48例LCT结果正常,阴道镜病理诊断为宫颈癌前病变(C IN),LCT假阴性发生率为2.58%。②48例LCT假阴性患者中,19例为重度宫颈糜烂,其病灶位于距宫颈外口≥1 cm处的转化区内,宫颈取材遗漏;12例为血染抹片,造成标本不满意;6例宫颈形态凹凸不平、3例合并宫颈息肉,均不利毛刷取材;8例原于细胞病理阅片漏诊。结论:宫颈LCT的假阴性结果是临床上不可完全杜绝的现象。获取满意的宫颈细胞标本、注重转化区和病变部位的取材、增强细胞病理医生的阅片水平是降低宫颈LCT假阴性的有效方法。对临床可疑但细胞学阴性的病例采取阴道镜下多点活检送病理检查可弥补假阴性的疏漏。
Objective: To investigate the causes of false negative results of cervical cytology thin layer cytology (LCT). Methods: The results of LCT and microscopic biopsy were retrospectively analyzed from 2006 to 2009 in patients with colposcopy due to various indications. RESULTS: Among the 1 859 cases with colposcopy, LCT of 48 cases was normal, colposcopy pathological diagnosis of cervical precancerous lesions (CIN), LCT false negative rate was 2.58%. Among the 48 LCT false-negative patients, 19 were severe cervical erosion, the lesion was located in the transformation zone ≥1 cm away from the cervix, the cervical material was missing, 12 cases were bloody smear, which caused unsatisfactory specimens; 6 cases Uneven cervical morphology, 3 cases of cervical polyps, are unfavorable brush drawing; 8 cases of the original missing in the cytopathological reading film. Conclusion: The false negative results of cervical LCT can not be completely eliminated in clinic. To obtain a satisfactory cervical cell specimens, focusing on the transformation area and the lesion site, enhance the pathological doctor’s reading level is to reduce cervical LCT false negative effective method. Clinical suspicious but cytologically negative case of colposcopy biopsy sent to check the pathology can make up for false negative omissions.