论文部分内容阅读
目的探讨宫颈细胞学检查联合宫颈局部组织中人乳头状瘤病毒(HPV)-DNA检测及阴道镜检查对宫颈病变筛查的必要性及价值。方法对4225例女性均采用薄层液基细胞学检查(TCT)及聚合酶链反应(PCR)法定性检测宫颈局部组织中HPV感染,对HPV-DNA阳性及TCT异常者行阴道镜及宫颈活体组织检查。结果 4225例中16例为TCT不满意标本,实际受检4209例中3713例TCT为正常范围或良性细胞改变,TCT在意义不明确的不典型鳞状细胞(ASC-US)及以上者496例。PCR法测定HPV-DNA阴性2828例,阳性885例。对152例ASC-US中HPV-DNA阳性的61例及所有高于ASC-US的344例均行阴道镜及宫颈组织活检。结果显示,HPV-DNA的阳性率随TCT(宫颈病变按TBS分类)ASC-US以上的逐级增高(ASC-US→ASC-H→L-SIL→SCC)而递升;随阴道镜检后组织病理学分类级别的逐级增高〔宫颈上皮内瘤变(CIN)Ⅰ→CINⅡ→CINⅢ→宫颈癌〕而递升。在宫颈癌,HPV-NDA均为阳性。TCT异常以30~40岁年龄段为最高,4例鳞状细胞癌均在45~50岁。结论 HPV-DNA检测与细胞学联合用于CIN及宫颈癌筛查,效率高于单纯使用细胞学检查;阴道镜检查可明确病变部位,进一步组织病理学可确定病变性质及程度,是诊断早期宫颈癌和癌前病变的关键检查手段。
Objective To investigate the necessity and value of cervical cytology combined with cervical papillomavirus (HPV) DNA test and colposcopy in the screening of cervical lesions. Methods Totally 4225 women were examined by thin-section liquid-based cytology (TCT) and polymerase chain reaction (PCR) to detect HPV infection in cervical local tissue. Colposcopy and cervical live-on HPV-DNA positive and TCT abnormalities were performed. Tissue examination. Results Of the 4225 cases, 16 were TCT unsatisfactory samples, 3713 cases of TCT in 4209 cases actually tested were normal range or benign cells, and TCT was detected in 496 cases of atypical squamous cell of unknown significance (ASC-US) . 2828 HPV-DNA negative samples were detected by PCR, and 885 were positive. Colitis and cervix biopsy were performed in 61 cases of HPV-DNA positive in 152 cases of ASC-US and 344 cases of all ASC-US higher than ASC-US. The results showed that the positive rate of HPV-DNA increased with the gradual increase of ASC-US (ASC-US → ASC-H → L-SIL → SCC) with TCT (cervical lesions by TBS classification) Pathological classification level by level (cervical intraepithelial neoplasia (CIN) Ⅰ → CIN Ⅱ → CIN Ⅲ → cervical cancer] and the rise. In cervical cancer, HPV-NDA are positive. TCT abnormalities in the 30 to 40 age group is the highest, 4 cases of squamous cell carcinoma are 45 to 50 years old. Conclusion HPV-DNA detection and cytology combined for CIN and cervical cancer screening, the efficiency is higher than the simple use of cytology; colposcopy can confirm the lesion, further histopathology can determine the nature and extent of the lesion is to diagnose early cervical Cancer and precancerous lesions of the key means of inspection.