宫颈细胞学诊断未能除外高度上皮内瘤样病变的不典型鳞状细胞的临床意义及处理  

Clinical significance and principle of treatment for atypical squamous cell which cannot exclude high-grade squamous intraepithelial lesion reported by Bethesda system.

作　　者：彭小萍[1] 刘继红[1] 李玉洁[1] 熊樱[1] Jeffrey Tan 

机构地区：[1]中山大学肿瘤防治中心妇科,广东广州510060 [2]Dysplasia Clinic of the Royal Women's Hospital

出　　处：《中国实用妇科与产科杂志》2006年第10期765-767,共3页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨宫颈细胞学诊断在未能除外高度上皮内瘤样病变(内瘤变)的不典型鳞状细胞(ASC-H)的意义和临床处理。方法1999-10-20-2004-01-24墨尔本皇家妇女医院宫颈病变门诊(DysplasiaClinicoftheRoyalWomen’sHospital,Melbourne)对96例宫颈细胞学诊断为ASC-H的患者进行阴道镜检查、阴道镜下活检或行宫颈锥切组织诊断学检查和高危型HPV-DNA测定,分析其结果之间关系。结果96例ASC-H中,87例有组织病理学诊断,58例诊断为宫颈鳞状上皮内瘤变(SIL)占66.6%(58/87),其中高度鳞状上皮内瘤变(HSIL)为44.8%(39/87),低度鳞状上皮内瘤变(LSIL)为21.8%(19/87)。96例行阴道镜检查,78例阴道镜下活检,阴道镜诊断与阴道镜下活检组织学诊断的符合率为64.1%(50/78),45例同时有阴道镜下活检病理和宫颈术后病理,两种方法病理诊断的符合率为73.3%(33/45)。以病理诊断为标准,阴道镜诊断的敏感性是89.4%,特异性是36.8%,阳性预测值是83.1%。32例做了HPV-DNA测定,阳性率为59.4%(19/32),阳性者中68.4%(13/19)经组织学诊断为HSIL。结论宫颈细胞学诊断为ASC-H高度提示宫颈鳞状上皮内瘤变(SIL)的存在。阴道镜检查、阴道镜下活检和高危型HPV-DNA的测定,对ASC-H的处理有重要的指导意义。Objectives The present study is designed to investigate the significance and strategy of treatment for ASC- H. Methods Form Dec. 20^th, 1999 to Jan. 24^th, 2004, In Dysplasia Clinic of the Royal Women＇ s Hospital, Melbourne,96 patients with a diagnosis of ASC-H were treated with colposcopy, biopsy under colposcope or by conization and high risk HPV-DNA examination. The results were analyzed. Results Among 96 patients of ASC-H, pathological diagnoses were obtained in 87 cases, with 66. 6% （58/87） diagnosed as SIL. Of the 58 cases of SIL, 38 cases were HSIL and 19 cases were LSIL. Colposcopy was done for all the 96 patients and 78 cases were taken biopsy during the procedure. The impression under colposcopy was consistent with the pathological diagnosis in 50 of 78 cases （64. 1% ）. Among 45 patients who had pathology obtained form both colposcopy-assisted biopsy and surgery, the diagnoses were consistent in 33 cases （73.3%）. Using pathology as gold criterion, the sensitivity of colposcopy was 89.4%, specificity was 36. 8% and positive predictive value was 83.1%. Thirty-two patients were tested for HPV-DNA, 19 cases （59.4%） were positive, and 13 cases of the HPV-DNA positive patients had a histological diagnosis of HSIL. Conclusions A diagnosis of ASC-H highly suggests the existence of SIL. For these patients, further evaluation using colposcopy, biopsy under colposcope and examination of HPV-DNA will provide important information for the selection of appropriate treatment.

关 键 词：宫颈 细胞学 阴道镜 鳞状上皮内瘤变 

分 类 号：R71[医药卫生—妇产科学]