197例宫颈非典型鳞状细胞与组织学诊断的对照研究及10例误诊分析  

Comparison of 197 cervical atypical squamous cells and histopathology detection and analysis of 10 error diagnosis

作　　者：王丽[1] 罗金芳[1] 叶宣光[1] 

机构地区：[1]复旦大学附属金山医院病理科,上海200540

出　　处：《诊断病理学杂志》2014年第1期13-15,18,共4页Chinese Journal of Diagnostic Pathology

基　　金：上海市金山区卫生局资助项目(2011-10)

摘　　要：目的对照宫颈非典型鳞状细胞与组织学诊断结果,分析误诊病例,探讨宫颈非典型鳞状细胞的诊断方法。方法回顾性分析197例行阴道镜下宫颈活检组织学诊断和宫颈液基薄层细胞检测(TCT)诊断的宫颈非典型鳞状细胞。并对细胞学诊断为非典型鳞状细胞—不能明确意义(ASC-US)、组织学诊断为鳞状细胞癌或CINⅢ的病例行显微镜下复检。结果 197例宫颈活检中ASC-US 140例,经宫颈活检组织学证实为阳性的病例占37.9%;非典型鳞状细胞—不除外上皮内高度病变(ASC-H)57例,经组织学证实为阳性的占61.4%。细胞学诊断为ASCUS,组织学诊断为鳞状细胞癌或CINⅢ的病例,细胞学主要呈现3种形态:少量的异型深染细胞,核浆比升高;深染的细胞巢团,结构不清,炎症背景明显;浅染的细胞团,核有重叠,形态较均一,部分可见核仁。结论 ASC-H与组织学诊断有较好的符合率,ASC-US中包含了少数更高级别的病变,需严格掌握诊断标准。Objective To compare the atypical squamous cells （ASC） in liquid-based cytology smears with the histological diagnosis, and to investigate the diagnosis of cervical atypical squamous ceils. Methods 197 cases of ASC were analyzed retrospectively, and the results were compared with the histological diagnosis. Those cases of cytologic diagnosis were ASC-US, but histological diagnosis were squamous cell carcinoma or CINIII were re-examined. Results The rate of histological positive cases in 140 ASC-US was 37.9% , confirmed by histological analysis of cervical biopsy; in 57 cases of ASC-H, the positive rate was 61.4%, confirmed by histology. We found that cases of ASC-US that were histologically diagnozed as squamous cell carcinoma or CIN m included following cells： slight atypical and hyperchromatic cells with high karyoplasmic ratio; trachychromatic cell nests with unclear structure and inflammatory background; understained cell nests with uniform shapes, some of which had indistinct uncleoli. Conclusion There is higher coincindence rate between cytological and histological diagnosis of ASC-H. Some high-grade cases may be bided in ASC- US. We must control strictly the diagnostic criteria.

关 键 词：宫颈非典型鳞状细胞 ASC—US ASC—H 细胞学 组织病理学 

分 类 号：R737.33[医药卫生—肿瘤]