宫颈上皮内瘤变三种形态学诊断方法的比较  

Comparison of three morphological diagnostic methods for patients with cervical intraepithelial neoplasia

作　　者：丘瑾[1] 王光花[1] 秦锦龙[1] 丁青[1] 童晓文[1] 

机构地区：[1]同济大学附属第十人民医院妇产科,上海200072

出　　处：《同济大学学报（医学版）》2008年第2期49-52,56,共5页Journal of Tongji University(Medical Science)

摘　　要：目的比较宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)三种形态学诊断方法——膜式液基薄层细胞学检查(liquid-based cytology test,TCT)、阴道镜下活组织检查、宫颈环状电切术(loop electrosurgical excision pro-cedure,LEEP)术后组织病理检查的结果。方法2005年3月至2007年4月,对在同济大学附属第十人民医院妇科就诊的妇女用细胞学检查、阴道镜下活组织检查及LEEP术后病理检查这三种方法诊断宫颈上皮内瘤变的结果进行总结、比较。结果共有6 651例妇女接受了TCT检查,发现异常者300例,包括非典型鳞状细胞不能明确意义(atypical squamous cells of undetermined significance,ASCUS)208例,非典型性鳞状细胞不除外上皮内高度病变(a-typical squamous cells:cannot exclude high grade SIL,ASC-H)4例,低度鳞状上皮内病变(1owgrade squamous intraepi-thelial lesion,LSIL)68例,高度鳞状上皮内病变(high grade squamous intraepithelial lesion,HSIL)13例,不典型腺细胞(atypical glandular cells,AGC)3例,鳞癌2例,腺癌1例。共有443例妇女接受了阴道镜下宫颈活检,其中宫颈细胞学结果异常的273例,病理诊断为CINⅠ105例,CINⅡ42例,CINⅢ20例,宫颈浸润癌8例。与TCT结果比较,低度病变诊断符合率50.75%,高度病变为92.31%,宫颈癌为100%。另有162例妇女接受了LEEP手术,共计发现CINⅠ39例,CINⅡ20例,CINⅢ17例;与阴道镜下活检结果比较,CINⅠ诊断符合率为58.19%,CINⅡ诊断符合率为48.00%,CINⅢ为61.90%。结论三种形态学方法虽然大大提高了CIN的检出率,但仍有较高的漏诊率,且诊断符合率较低。所以诊断CIN不能仅仅依赖于形态学诊断方法。Objective To compare the results of three morphological diagnostic methods for patients with cervical intraepithelial neoplasia, including cytological test（ liquid-based thin preparation cytology test, TCT）. cervical biopsy under colposcopy and loop electrosurgical excision procedure （LEEP）. Methods During March 2005 to April 2007, a total of 6 651 women in our department were screened by cytological tests and patients with abnormal cytological findings were further biopsied under colposcope. Results Among investigated patients,208 patients were diagnosed with atypical squamous cell of undetermined significance （ASCUS ） ,4 patients were of atypical squamous cells （can not exclude high grade SIL） （ASC-H） and 68 patients were found to be low-grade squamous intraepithelial lesion （LSIL）, 13 patients of high-grade squamous intraepithelial lesion （HSIL） and 3 cases with cervical carcinoma were detected by TCT including2 squamouse cell carcinoma and 1 adenocarcinoma. Four hundred and forty-three patients were tested by cervical biopsy under colposcopy,in which 273 cases were abnormal including 105 cases with CIN Ⅰ ,42 with CIN Ⅱ ,20 with CIN Ⅲ and 8 with infiltrating carcinoma. In comparison with the results of low-grade CIN,high-grade CIN and cervical carcinoma by biopsy,the agreement rate of TCT and colposcope was 50.75% ,92.31% and 100% ,respectively. A total of 162 cases were treated by conization of LEEP,in which 39 patients were diagnosed with CIN Ⅰ ,20 with CIN Ⅱ and 17 with CIN Ⅲ by histopathology. The coincidence of LEEP and col- poscope：for CIN Ⅰ was 58.19% ,for CIN Ⅱ was 48.00% and for CIN was 61.90% ,respectively. Conclusion Despite of the success of three morphological methods, precise diagnosis of CIN is still difficult and has high rate of mis diagnosis and low diagnostic accordance rate. So the diagnosis of CIN cannot depend on morphological methods only.

关 键 词：宫颈上皮内瘤变 液基细胞薄片 阴道镜检查 宫颈电圈环切术 活组织检查 

分 类 号：R71[医药卫生—妇产科学]