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目的:探讨液基细胞学检查(Thinprep cytology test,TCT)在宫颈病变普查中的应用价值。方法:2009年1月～2012年12月对接受宫颈病变普查的已婚妇女进行宫颈液基细胞学检查,并与组织病理结果进行对比,以探讨其在宫颈病变筛查中的应用价值。结果:2 060例液基细胞学诊断样本中共检出312例TCT阳性者,阳性率为15.15%(312/2 060),其中ASC-US 56例(17.95%),ASC-H 48例(15.38%),LSIL 164例(52.56%),HSIL 32例(10.26%),CA 12例(3.85%);TCT诊断结果与活检病理诊断不完全一样,但是两种检查方法的符合率比较无统计学差异(χ2=1.08,P>0.05)。宫颈病变高发人群集中在生育及性活跃年龄段(31～40岁),另外CIN和HPV感染在≤20岁和>60岁发病率明显减少。从患者的病变程度来看,只有HPV感染而未发展成为CIN者居多,其次是CINⅠ。以一般人群发生CINⅠ、CINⅡ、CINⅢ的风险为基准,液基细胞学阳性者发生宫颈病变的危险明显上升,随着液基细胞学级别的增加,发生高度病变的危险也增加。结论:液基薄层细胞学检查技术明显提高了宫颈病变的阳性检出率,TCT阳性者发生宫颈病变的危险较一般人群明显升高,减少了漏诊率,对病理结果有一定的预测价值,值得临床推广使用。
Objective: To investigate the value of Thinprep cytology test (TCT) in the screening of cervical lesions. Methods: From January 2009 to December 2012, cervical liquid-based cytology was performed on married women undergoing cervical disease screening and compared with histopathological findings to explore its value in the screening of cervical lesions. Results: A total of 312 TCT positive cases were detected in 2 060 liquid-based cytology samples. The positive rate was 15.15% (312/2 060), of which ASC-US 56 cases (17.95%) and ASC-H 48 cases (15.38 (52.56%) in LSIL, 32 cases (10.26%) in HSIL and 12 cases (3.85%) in CA. The diagnostic results of TCT were not exactly the same as those of biopsy, but the coincidence rates of the two methods were not statistically significant Difference (χ2 = 1.08, P> 0.05). High incidence of cervical lesions concentrated in the reproductive and sexual active age (31 to 40 years old), the other CIN and HPV infection in ≤ 20 years old and> 60 years old significantly reduced the incidence. From the degree of patient’s disease point of view, only HPV infection and did not develop into CIN are mostly followed by CIN Ⅰ. Based on the risk of CINⅠ, CINⅡ and CINⅢ in the general population, the risk of developing cervical lesions is significantly increased in liquid-based cytology patients. With the increase of liquid-based cytology, the risk of developing high-grade lesions also increases. Conclusion: The liquid-based cytology examination significantly improves the positive rate of cervical lesions. The risk of developing cervical lesions is significantly higher in TCT-positive patients than in the general population, which reduces the rate of misdiagnosis and has certain predictive value for the pathological findings. It is worth to promote clinical use.