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目的:评价宫颈液基细胞学检查在宫颈癌筛查中的敏感性和价值,探讨宫颈病变的相关规律。方法:收集广东省妇幼保健院及广东省48个市县妇幼保健院门诊、住院患者送本院检测的宫颈液基细胞学标本57372例,采用TBS分级系统,意义不明确的非典型鳞状上皮细胞(ASC-US)以上病变为阳性病例,对其中细胞学结果阳性或阴性,但临床怀疑宫颈病变共计4214例,进一步行阴道镜及镜下取活检作组织病理学对照观察,对诊断结果进行比较分析。结果:57372例标本中,49052例(85.50%)未见上皮内病变或恶性病变(NILM),3870例(6.75%)非典型鳞状上皮细胞(ASC)、3862例(6.73%)低级别鳞状上皮内病变(LSIL)、470例(0.82%)高级别鳞状上皮内病变(HSIL)、32例(0.06%)鳞状细胞癌(SCC)、非典型腺上皮细胞(AGC)72例(0.13%)和腺癌(AC)14例(0.02%)。与病理组织学对照的4124例中,细胞学检出100.00%(46/46)鳞状细胞癌(SCC);100.00%(12/12)腺癌(AC);94.42%(372/394)高级别鳞状上皮内病变(HSIL);80.99%(1806/2230)低级别鳞状上皮内病变(LSIL)。CINⅠ、CINⅡ、CINⅢ、鳞癌和腺癌平均年龄分别是(33.30±13.28)岁、(35.30±7.83)岁、(72.25±7.61)岁、(45.61±6.73)岁和(42.67±10.13)岁。结论:宫颈病变,尤其是宫颈癌前病变的发病有年轻化趋势。液基细胞学能更有效地检出宫颈各类病变,结合阴道镜检查,更有助于预防宫颈癌的发病和降低宫颈癌的死亡率。
Objective: To evaluate the sensitivity and value of cervical liquid-based cytology in cervical cancer screening and to explore the related rules of cervical lesions. Methods: Fifty-seven (37372) cases of cervical liquid-based cytology specimens from outpatient and inpatient hospital of Guangdong Provincial Maternal and Child Health Hospital and 48 maternal and child health care centers in Guangdong Province were collected. TBS classification system, atypical squamous epithelium of uncertain significance (ASC-US) above lesions were positive cases, of which the cytology results were positive or negative, but the clinical suspicion of cervical lesions a total of 4214 cases, further colposcopy and microscopy biopsy for histopathological control of the diagnosis results comparative analysis. Results: Among the 57372 cases, none of the 4952 cases (85.50%) had intraepithelial neoplasia or malignant neoplasm (NILM), 3870 (6.75%) atypical squamous cells (ASC), 3862 (6.73% 470 cases (0.82%) of high grade squamous intraepithelial lesion (HSIL), 32 cases (0.06%) squamous cell carcinoma (SCC), atypical glandular epithelial cells (AGC) 0.13%) and adenocarcinoma (AC) in 14 cases (0.02%). Of 4124 cases with pathological histology, 100.00% (46/46) SCC, 100.00% (12/12) adenocarcinoma (AC) and 94.42% (372/394) Grade squamous intraepithelial lesion (HSIL); 80.99% (1806/2230) low grade squamous intraepithelial lesion (LSIL). The average age of CINⅠ, CINⅡ, CINⅢ, squamous cell carcinoma and adenocarcinoma were (33.30 ± 13.28) years old, (35.30 ± 7.83) years old, (72.25 ± 7.61) years old, (45.61 ± 6.73) years old and (42.67 ± 10.13) years old. Conclusion: Cervical lesions, especially cervical precancerous lesions have a younger trend. Liquid-based cytology can detect all kinds of cervical lesions more effectively, combined with colposcopy, but also help prevent the incidence of cervical cancer and reduce the mortality rate of cervical cancer.