宫颈细胞学检查和组织学病理对照研究  

Relativity Analysis of Abnormal Cervical Pathology Results in Cytology and Histology

作　　者：李彩娟[1] 郎景和[1] 程雪梅[1] 王友芳[1] 

机构地区：[1]北京协和医院妇产科,100730

出　　处：《医学研究杂志》2006年第8期8-11,共4页Journal of Medical Research

摘　　要：目的研究宫颈TCT检查结果与阴道镜活检病理及宫颈锥形切除病理间的相关性。方法回顾性地总结了2001年1月-2003年3月间北京协和医院妇产科细胞学实验室采用膜式液基超薄细胞学检测系统（TCT）收集宫颈细胞总计31634人次的检测，报告结果使用TBS分类系统。其中细胞学筛查为异常结果根据临床医师建议行阴道镜检查及活检和（或）宫颈锥形切除。描述上述TCT检查结果和病理检查结果之间的关系，将阴道镜宫颈组织病理证实为CINⅡ-Ⅲ和CINⅢ／CIS的患者按年龄构成进行了分组分析，并对TCT检查结果与病理结果行统计学的相关性分析。结果31634人次的TCT检测中，948例有明确的阴道镜宫颈组织病理结果，其中病理证实为CINⅡ-Ⅲ的患者共计70人，病理证实为CINⅢ／CIS的患者共计56人。不同的异常细胞学结果提示CINⅢ／CIS的风险系数（RR）分别为：ASCUS，14．7（95％可信区间8．0—27．0，P为0．00）；CINⅠ，13．9（95％可信区间6．3—30．9，P为0．00）；CINⅡ，44．2（95％可信区间15．5—126．5，P为0．00）；CINⅢ，272．2（95％可信区间161．6—458．6，P为0．00）；Cancer的RR无法计算。其中TCT提示ASCUS及CINⅠ两组间检出CINⅢ／CIS病变的RR值无显著差异（P为0．951）。结论阴道镜检查及活检可以较好地检出TCT异常病例中的CINⅡ-Ⅲ及CINⅢ／CIS组织学类型，其病理结果与宫颈锥切病理结果符合满意。TCT提示异常细胞学结果的病例，其组织学病理为CINⅢ／CIS的风险远大于正常人群；其中TCT为ASCUS的病例，与TCT为宫颈低度病变（CINⅠ）的病例，其组织学病理为CINⅢ／CIS的风险是相同的。Objective To study the relativity analysis of abnormal cervical pathology results in cytology and histology. Methods With retrospective analysis of 31,634 cases of fluid -based thin- layer method （ThinPrep Cytology Test, TCT） of PUMC Hospital from January, 2001 to March, 2003, which reported in the Bethesda System, we checked the abnormal results and advised different diagnose biopsy of vaginoscopy and/or conization, and got the relativity description of abnormal results in TCT and CINⅢ /CIS results validated by vaginoscopy, match analysis of the CIN Ⅱ-Ⅲ and CINⅢ /CIS results validated by vaginoscopy and conization labeled by the age group, and relativity analysis of abnormal results in TCT and CIN Ⅲ/CIS results validated by vaginoscopy. Results Among 31,634 cases of TCT test, 948 cases had confirmed biopsy results validated by vaginoscopy, of which 70 cases were of CIN Ⅱ-Ⅲ , 56 cases were of CINⅢ/ CIS. The risk ratio （RR） of different abnormal TCT results in predicting CINⅠn/CIS resuhs validated by vaginoscopy is： ASCUS group, 14.7（95% confidence interval 8.0 - 27.0 ,P =0.00） ;CINⅠ group,13.9（6.3 - 30.9 ,P =0.00） ;CIN Ⅱ group ,44.2（ 15.5 - 126.5 ,P = 0.00） ;CIN Ⅲ group,272.2 （ 161.6 - 458.6, P = 0.00 ） ; Cancer group, unmeasured. As noted, there is no significant difference between the RR of ASCUS group and CINⅠ group（ P = 0. 951 ）in predicting CINⅢ/CIS results. Conclusions Vaginoscopy examination and biopsy could verify histology abnormity of CINⅡ-Ⅲ CINⅢ/CIS from abnormal results of TCT, and has a good accordance along with biopsy results of conization. There are significantly greater risk of being CIN Ⅲ/CIS validated by vaginoscopy in the abnormal TCT patients, among which ASCUS group and CINⅠ group have the coequal risk.

关 键 词：TCT 阴道镜 锥形切除 宫颈上皮内瘤变 原位癌 

分 类 号：R737.33[医药卫生—肿瘤] R739.45[医药卫生—临床医学]