论文部分内容阅读
目的探讨宫颈细胞学结果中未明确意义的不典型鳞状上皮细胞(ASCUS)与低度鳞状上皮内病变(LSIL)的临床意义。方法对宫颈细胞学结果 ASCUS 405例与 LSIL 395例的患者行阴道镜检查,并在其指引下行宫颈及/或外阴部位的活检术、宫颈管内膜刮取术(ECC)及子宫颈电热圈切除术(LEEP),以组织病理学诊断为金标准,评估阴道镜检查诊断宫颈癌及其癌前期病变的敏感性、特异性、阳性预测值与符合率,随访结局。结果 (1)组织病理学诊断结果:405例 ASCUS 患者中慢性宫颈炎231例(57.04%)、宫颈低度鳞状上皮内病变(LSIL)141例(34.81%)、高度鳞状上皮内病变(HSIL)16例(3.95%)、宫颈鳞癌(sCC)Ⅰ a1期2例(0.49%);外阴上皮内瘤变(VIN)15例(3.70%)。395例 LSIL 患者中慢性宫颈炎135例(34.18%)、宫颈 LSIL 201例(50.89%)、HSIL 41例(10.38%)、SCCⅠ a1期2例(0.51%);VIN15例(3.80%)、外阴鳞癌1例(0.25%)。(2)阴道镜诊断宫颈癌及其癌前期病变的敏感性、特异性、阳性预测值及与组织学符合率分别为:96.17%、58.41%、73.34%、79.63%。(3)随访结果:HSIL 及 HSIL~+患者全部在访,经临床干预后病变消退,随访1年以上无进展。738例宫颈炎、LSIL 及 VIN 患者半年之内全部在访,其中501例随访1年以上(随访率67.89%)。结论宫颈细胞学结果 ASCUS/LSIL 患者,其组织学诊断的分类具多样性:包括宫颈上皮的良性改变,也包括不同级别的 CIN 及少数的癌。借助阴道镜检查全面评估女性下生殖道,不仅可以早期检出 HSIL 与宫颈癌,还可及时检出 VIN 与外阴癌,其临床价值值得关注。
Objective To investigate the clinical significance of undetermined significance of ASCUS and LSIL in cervical cytology. Methods Cervical and / or genital biopsies, cervical endometrial scraping (ECC), and cervix electric coil were performed on colposcopy patients with cervical cytology ASCUS 405 cases and LSIL 395 cases. (LEEP), histopathological diagnosis as the gold standard, assessment of colposcopy diagnosis of cervical cancer and precancerous lesions of the sensitivity, specificity, positive predictive value and coincidence rate, follow-up results. Results: (1) Histopathological diagnosis results showed that there were 231 cases (57.04%) of chronic cervicitis in 405 cases of ASCUS, 141 cases (34.81%) of low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion HSIL) 16 cases (3.95%), cervical squamous cell carcinoma (sCC) Ⅰ a1 2 cases (0.49%); vulvar intraepithelial neoplasia (VIN) 15 cases (3.70%). 135 cases (34.18%) of chronic cervicitis, 201 cases of cervical LSIL (50.89%), 41 cases of HSIL (10.38%) and 2 cases of SCCⅠa1 (0.51%) in 395 cases of LSIL. VIN15 cases (3.80% Squamous cell carcinoma in 1 case (0.25%). (2) The sensitivity, specificity, positive predictive value and histological coincidence of colposcopy in diagnosing cervical cancer and precancerous lesions were 96.17%, 58.41%, 73.34% and 79.63% respectively. (3) The follow-up results: All the patients with HSIL and HSIL ~ + were interviewed, and the lesions subsided after the clinical intervention. There was no progress for more than one year after follow-up. 738 cases of cervicitis, LSIL and VIN patients were interviewed within six months, of which 501 cases were followed for more than 1 year (follow-up rate was 67.89%). Conclusions Cervical cytology results ASCUS / LSIL patients with a variety of histological diagnosis of classification: including the benign changes of the cervical epithelium, but also include different levels of CIN and a few cancers. Colposcopy with a comprehensive assessment of the lower genital tract in women, not only early detection of HSIL and cervical cancer, but also promptly detected VIN and vulvar cancer, its clinical worth attention.