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[目的]探讨宫颈不典型鳞状细胞—不除外高级别鳞状上皮内病变(ASC-H)的临床意义及形态学诊断标准。[方法]对绍兴医院2005年至2010年TCT诊断为ASC-H的170例病例进行回顾性分析;对其中160例组织学证实为鳞状细胞病变的TCT涂片进行8种细胞病理形态学特征双盲评判,结合对应组织学诊断,对8种细胞学特征进行单因素分析及逐步Logistic回归分析,分析ASC-H的诊断中倾向高级别鳞状上皮内病变(HSIL)的细胞学特征。[结果]170例ASC-H样本中,宫颈活检或术后病理组织学诊断为慢性宫颈炎42例(24.71%),宫颈上皮内瘤变Ⅰ级(CINⅠ)或及湿疣样改变37例(21.76%),CINⅡ34例(20.00%),CINⅢ26例(15.29%),鳞状细胞癌21例(12.35%),腺上皮不典型增生6例(3.53%),腺癌2例(1.18%),腺鳞癌1例(0.59%),恶性黑色素瘤1例(0.59%);逐步Logistic回归分析结果显示,多形性核、合体状细胞片及不规则核膜与HSIL有关联(P<0.05)。[结论]ASC-H是一个疾病谱,可为宫颈炎性病变到CIN各级别甚至宫颈鳞癌或其他恶性肿瘤,临床处理应行阴道镜检查并活检。在ASC-H的诊断中,对细胞形态应综合评判,若出现多形性核、合体状细胞片及不规则核膜时,更倾向于诊断HSIL。
[Objective] To investigate the clinical significance and morphological diagnostic criteria of cervical atypical squamous cell-non-high-grade squamous intraepithelial lesion (ASC-H). [Methods] A total of 170 cases of ASC-H diagnosed by TCT in Shaoxing Hospital from 2005 to 2010 were analyzed retrospectively. Totally 160 TCT smears histologically confirmed as squamous cell lesions were used for 8 kinds of cytopathological features Double-blind evaluation combined with the corresponding histological diagnosis, univariate analysis and stepwise logistic regression analysis of 8 cytological features, cytological features of high-grade squamous intraepithelial lesion (HSIL) in the diagnosis of ASC-H were analyzed. [Results] Among 170 ASC-H samples, 42 cases (24.71%) were diagnosed as chronic cervicitis by cervix biopsy or postoperative histopathology, 37 cases (21.76%) had cervical intraepithelial neoplasia grade Ⅰ (CINⅠ) (20.00%) of CINⅡ, 26 cases (15.29%) of CINⅢ, 21 cases (12.35%) of squamous cell carcinoma, 6 cases (3.53%) of adenomatous dysplasia, 2 cases of adenocarcinoma (1.18%), One case of squamous cell carcinoma (0.59%) and one case of malignant melanoma (0.59%). Logistic regression analysis showed that polymorphonuclear, syncytial cell sheets and irregular nuclear membrane were associated with HSIL (P <0.05). [Conclusion] ASC-H is a disease spectrum, which may be cervical inflammatory lesions to CIN or even cervical squamous cell carcinoma or other malignant tumors. Clinical treatment should be colposcopy and biopsy. In the diagnosis of ASC-H, cell morphology should be comprehensive assessment, if polymorphonuclear, syncytial cell sheets and irregular nuclear membrane, the more inclined to diagnose HSIL.