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目的探讨液基细胞学(TCT)在宫颈病变诊断中的价值。方法分析3 720例TCT筛查患者的临床资料,其中756例行阴道镜检查并活检,对比分析TCT与活检资料。结果 3 720例TCT中,病变细胞阳性率11.56%(430/3 720);意义不明非典型鳞状上皮细胞(ASC-US)阳性率4.11%(153/3720);非典型腺上皮细胞(AGC)阳性率0.19%(7/3720)。756例TCT与活检对比分析发现:153例TCT报告ASC-US病例活检后发现68例阳性病例,阳性率为44.44%(68/153);7例TCT报告AGC病例活检后发现3例病变,阳性率42.86%(3/7);430例无上皮内病变或恶性病变(NILM)活检后发现低度上皮内病变(LSIL)8例,假阴性率为1.86%(8/430),高度鳞状上皮内病变(HSIL)3例,假阴性率为0.69%(3/430);113例TCT报告LSIL的病例活检后发现15例为宫颈慢性炎,假阳性率为13.27%(15/113);48例TCT报告HSIL的病例活检后发现2例为宫颈慢性炎,假阳性率为4.17%(2/48);113例TCT报告为LSIL的病例活检后发现鳞状细胞癌(SCC)1例,过低诊断率0.88%(1/113);48例TCT报告HSIL的病例活检后发现SCC 3例,过低诊断率6.25%(3/48);7例TCT报告AGC病例活检后发现宫颈上皮内瘤变(CIN)Ⅰ级1例、CINⅡ级2例;48例TCT报告HSIL活检后发现2例,第一次活检阴性,第二次活检加宫颈管诊刮后为CINⅢ级。结论 TCT作为宫颈病变的初筛方法,有一定的漏诊率,结合阴道镜下活检及宫颈管搔刮(ECC),能明显降低漏诊率,提高诊断准确性,只有TCT、阴道镜活检及宫颈管搔刮相结合,才能做到尽量减少宫颈病变的漏诊,做到尽早发现,极早治疗。
Objective To investigate the value of liquid-based cytology (TCT) in the diagnosis of cervical lesions. Methods Clinical data of 3 720 cases of TCT screening were analyzed. Among them, 756 cases underwent colposcopy and biopsy, and TCT and biopsy data were compared. Results The positive rate of diseased cells was 11.56% (430/3 720) in 3 720 cases of TCT. The positive rate of ASC-US with unknown significance was 4.11% (153/3720) in atypical squamous cells (ASC-US) ) Positive rate of 0.19% (7/3720). A total of 686 positive cases were detected by biopsy in 756 TCT cases and ASC-US cases, with a positive rate of 44.44% (68/153). Three of the 7 TCT cases reported positive biopsy results in AGC cases Rate was 42.86% (3/7). There were 8 cases of low grade intraepithelial lesion (LSIL) in 430 cases of non-epithelial lesions or malignant lesions (NILM). The false negative rate was 1.86% (8/430) Three cases of intraepithelial lesion (HSIL) had a false negative rate of 0.69% (3/430). Of 113 cases with LSIL reported biopsy, 15 cases were chronic cervicitis and the false positive rate was 13.27% (15/113). Two cases of chronic cervicitis and 48 cases of chronic cervicitis were found in 48 TCT cases after biopsy, and the false positive rate was 4.17% (2/48). One case of squamous cell carcinoma (SCC) was found after biopsy in 113 cases with TCL reported as LSIL, The diagnosis rate was 0.88% (1/113) too low. In 48 cases of HSIL after biopsy, 3 cases of SCC were found by SCT biopsy, the rate of diagnosis was 6.25% (3/48) One case of grade Ⅰ (CIN) and 2 cases of CINⅡ (grade 2) were found in 48 cases of TCN. Two cases were found after HSIL biopsy in TCT, the first biopsy was negative, and the second biopsy plus cervical canal was CINⅢ. Conclusion TCT as a screening method for cervical lesions, there is a certain misdiagnosis rate, combined with colposcopy biopsy and cervical scraping (ECC), can significantly reduce the rate of misdiagnosis and improve the diagnostic accuracy, only TCT, colposcopy and cervical canal Combination of scratch, in order to minimize the misdiagnosis of cervical lesions, so as early as possible to find early treatment.