对2001年TBS系统中不典型鳞状细胞分型及诊断标准的评价——附1186张宫颈细胞学涂片分析  

Comment on diagnosis of atypical squamous cells using new the Bethesda system (2001)

作　　者：王莹[1] 卞美璐[1] 刘军[1] 

机构地区：[1]中日友好医院妇产科,北京100029

出　　处：《中华妇产科杂志》2004年第1期27-29,共3页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的　初步评价 2 0 0 1年修订的TBS系统中关于不典型鳞状细胞 (ASC)及其两种亚型 ,即意义不明确的不典型鳞状细胞 (ASC US)和不除外高度上皮内病变的不典型鳞状细胞 (ASC H)诊断标准 (修订标准 )的临床指导意义。方法　对 1186例按TBS系统修订前使用的诊断标准 (修订前标准 ) ,诊断为未明确诊断意义的不典型鳞状上皮细胞 (ASCUS)的宫颈细胞抹片或薄片 (涂片 ) ,以修订标准重新进行诊断 ;对其中 16 8例以细胞学诊断后 6个月内进行的阴道镜下宫颈活组织检查、高频环型电刀切除术的组织病理学检查结果作为标准 ,评价修订标准的细胞学结果。结果　以修订标准重新诊断的 1186例宫颈细胞涂片中 ,宫颈细胞学检查阴性 2 85例 ( 2 4 0 % ) ,ASC US 6 2 7例 ( 5 2 9% ) ,ASC H 2 5 4例 ( 2 1 4 % ) ,低度上皮内病变 (LSIL) 16例 ( 1 3% ) ,高度上皮内病变 (HSIL) 4例( 0 3% )。以修订标准重新诊断、有组织病理学结果的 16 8例中 ,为ASC H、组织病理学结果为宫颈上皮内瘤变 (CIN)Ⅱ、Ⅲ级者为 18 9% ,明显高于ASC US患者的 5 2 % (P <0 0 5 ) ,和以修订前标准诊断的ASCUS( 14 3% )。在 6个月的随诊过程中 ,5例ASC US细胞学检查结果升级 ( 4例为LSIL ,1例为HSIL) ,4例ASC H细胞学检查结果升级 ( 2例为LSIL 。Objective To evaluate the criteria for diagnosis of atypical squamous cells(ASC)and its two subtypes: undetermined significance ASC (ASC US) and atypical squamous cells cannot exclude high grade intraepithelial lesion (HSIL, ASC H) defined in 2001 the Bethesda system(TBS) Method One thousand one hundred and eighty six pap smears and liquid based thin layer preparations with diagnosis of atypical squamous cells of undetermined signification (ASCUS) according to TBS 1991 criteria, were re classified by a cytopathologist using TBS 2001 criteria Results The cytologic diagnosis according to TBS 2001 criteria was: negative in 285 cases(24 0 %), ASC US in 627 cases (52 9 %), ASC H in 254 cases(21 4 %), low grade intraepithelial lesion (LISL) in 16 cases(1 3 %), and HISL in 4 cases (0 3 %), respectively Out of 1186 cases, 168 received histological examination Cervical intra epithelial neoplasia (CIN) II III were diagnosed in 18 9 % of patients with ASC H, 5 2% of patients with ASC US, and 14 3% of patients with ASCUS defined by using TBS 1991 criteria, respectively ( P <0 05) During the follow up of 6 months, 4 cases of ASC US changed to LSIL, one ASC US changed to HSIL, 2 ASC US changed to LSIL, and 2 ASC US to HSIL Conclusions New classification of ASC recommended by 2001 TBS has apparent clinical significance Colposcopically directed cervical biopsy should be performed immediately if ASC H is diagnosed In ASC US patients, checking of cervical smear in an interval of 3～6 months is necessary It is suggested to use ASC US and ASC H instead of ASCUS in cytological diagnosis

关 键 词：2001年 TBS系统 鳞状细胞 分型 诊断标准 评价 宫颈细胞学涂片 癌前状态 

分 类 号：R361[医药卫生—病理学]