液基细胞学结合阴道镜检查在北京市社区妇女宫颈病变筛查中的意义  

Value of Hquid-based cytology and colposcopy in screening for cervical lesion among urban community women of Beijing

作　　者：赵超[1] 李静[2] 屠铮[1] 宋丹 崔淑慧[1] 章文华 乔友林 王建六[1] Belinson JL 魏丽惠[1] 

机构地区：[1]北京大学人民医院妇科,100044 [2]中国医学科学院肿瘤研究所,100044 [3]Cleveland Clinic Foundation,USA

出　　处：《中华全科医师杂志》2008年第5期305-308,共4页Chinese Journal of General Practitioners

基　　金：基金项目：癌症基金会与美国克利夫兰医学中心合作项目,北京地区宫颈病变的现状调查及防治对策的研究课题（D090608040391）资助.

摘　　要：目的探讨宫颈液基细胞学及阴道镜检查在北京市社区妇女宫颈病变筛查中的临床意义。方法2006年6月至2007年6月对北京市展览路社区的795位20～54岁有性生活的妇女进行筛查。筛查对象接受妇科检查时，留取宫颈超柏氏薄层液基细胞学检测标本，并对宫颈细胞学异常者行阴道镜检查及活组织检查。结果宫颈细胞学阳性[≥ASC-US（不能明确意义的不典型鳞状细胞）]45例，占5．7％（45／795）。其中ASC-US33例，占73．3％（33／45）；低度鳞状上皮内病变8例；高度鳞状上皮内病变3例；不典型腺细胞1例。细胞学阴性750例，占94．3％（750／795）。宫颈细胞学阳性的45例中，5例拒绝行阴道镜检查，占11．1％（5／45）。在行阴道镜活组织病理检查的40例中，慢性宫颈炎11例（27．5％）；宫颈湿疣14例（35．0％）；宫颈上皮内瘤样病变（CIN）1为7例（17．5％）；CIN2为3例（7．5％）；CIN3为4例（10．0％）；早期浸润癌1例（2．5％）。细胞学阴性的750例中，宫颈湿疣2例（0．3％）；CIN1为5例（0．7％）；宫颈低级别腺上皮内病变1例（0．1％）。宫颈液基细胞学筛查CIN1及以上宫颈病变和宫颈癌的敏感度71．4％，特异度94．2％，阳性预测值37．5％，阴性预测值99．2％；筛查CIN2及以上宫颈病变和宫颈癌的敏感度100．0％，特异度96．0％，阳性预测值20．5％，阴性预测值100．0％。结论应重视并及时进行北京市社区人群宫颈病变的早期筛查，薄层液基细胞学结合阴道镜活组织检查及病理学检查，对提高早期宫颈癌筛查的准确性效果明显。Objective To study the value of liquid-based cytology and colposcopy in screening for cervical lesion among urban community women of Beijing. Methods A total of 795 women aged 20 - 54 years with sexual activity living in Zhanlanlu Community of Beijing were screened for cervical lesion. Cervical specimen was collected for thin-layer, liquid-based cytology test （LCT） from each of the participants in gynecologic examination. Colposcopy and biopsy were performed for the women with positive LCT. Results Forty-five of 795 （5.7%） women were positive for LCT [≥ ASC-US （ atypical squamous cell of undetermined significance） ], with 33 of ASC-US, eight of low-grade squamous intraepithelial lesion （LSIL）, three of high-grade squamous intraepithelial lesion （HSIL）, one of atypical glandular cells （AGC）. Five of 45 women with positive LCT refused to accept colposcopy. Among 40 women with colposcopy and biopsy, chronic cervicitis was diagnosed in 11 （27. 5% ）, cervical condyloma acuminatum in 14 （35.0%）, cervical intraepithelial neoplasia （CIN） 1 in seven （ 17.5% ）, CIN 2 in three （7. 5% ）, CIN 3 in four （10. 0% ）, and early invasive cervical cancer in one （2. 5% ）. In 750 women with negative LCT, cervical condyloma acuminatum was diagnosed in two （0. 3% ）, CIN 1 in five （0. 7% ） and low-grade glandular intraepithelial lesion （LGIL） in one （0. 1% ）. Sensitivity and specificity of LCT screening for cervical lesion （ ≥ CIN 1 ） were 71.4% and 94.2%, respectively, with positive and negative predictive values of 37. 5% and 99. 2% , respectively, and those screening for cervical lesion more than CIN 2 were 100. 0% ,96. 0% ,20. 5% and 100. 0% , respectively. Conclusions More attention should be paid to early screening for cervical lesion in urban community women. LCT combined with eolpescopy and biopsy provide very helpful information in screening for early cervical cancer.

关 键 词：宫颈肿瘤 细胞学技术 阴道镜检查 

分 类 号：R737.33[医药卫生—肿瘤]