摘要
目的探讨影响宫颈液基细胞学高度鳞状上皮内病变（HSIL）诊断准确性的原因。方法收集2007至2010年间415例细胞学诊断为HSIL的病例，将细胞学结果与组织学结果对照分析，复查液基细胞学制片及组织学切片，分析误诊原因。结果共42209例受检者进行了ThinPrep液基细胞学检查，其中细胞学诊断为HSIL者415例，占筛查人群的1．0％。HSIL患者的平均年龄41．6岁，30～49岁为高发年龄。325例细胞学诊断为HSIL的病例其组织学诊断结果为：阴性／炎性改变23例（7．1％），宫颈上皮内病变（CIN）1级／人乳头状瘤病毒（HPV）感染22例（6．8％），CIN2级／CIN3级223例（68．6％），鳞状细胞癌（SCC）57例（17．5％）。细胞学HSIL对组织学CIN2级及以上病变的阳性预测值为86．2％（280／325），对组织学CIN1级以上病变的阳性预测值为92．9％（302／325）。细胞学假阳性的原因主要是组织学取材阴性、细胞学片中出现反应性腺上皮、孤岛状萎缩及放化疗反应等。细胞学诊断为HSIL而组织学诊断为SCC者57例（17．5％），误诊的原因主要为社会因素、对部分低分化SCC的细胞学表现认识不足，以及细胞学片中缺乏典型癌性特征。结论细胞学HSIL对宫颈CIN2级／CIN3级及SCC的阳性预测值较高，但存在与组织学诊断结果不符的情况，细胞学医师和妇科医师应注意避免造成不一致的因素。
Objective To investigate factors affecting the diagnostic accuracy of cervical liquid- based cytology for high-grade squamous intraepithelial lesion （HSIL）. Methods A retrospective evaluation of cytological and histological slides was performed in 415 patients who had cytological HSIL between 2007 and 2010. Results Among 42 209 cases screened by ThinPrep liquid-based cytology, 415 cases （ 1.0% ） of HSIL were eventually identified. The mean age of HSIL patients was 41.6 years, and 30 -49 years were the most common age group. Among 415 cases, 325 patients had available histological diagnosis as follows： 23 （7. 1% ） negative, 22 （6. 8% ） CIN1/HPV, 223 （68.6%） CIN2/CIN3, and 57 （ 17.5% ） squamous cell carcinoma （SCC）. The positive predictive values of HSIL to predict CIN2 （or higher grade of dysplasia） and CIN1 were 86. 2% （280/325） and 92. 9% （ 302/325 ）, respectively. Inadequate biopsy, reactive glandular cells, islet atrophy, chemo/radiotherapy and others were responsible for the cytologically false-positive diagnosis. Fifty-seven （17.5%） cases of HStL had a histological diagnosis of SCC. The possible causes of misdiagnosis were social factors, under-recognized cytological features of poorly- differentiated SCC and absence of typical diagnostic features in cytology slides. Conclusions Cytology of HSIL has a high positive predictive value for the presence of CIN2/CIN3 and SCC. Cytologists and gynecologists should be aware of the diagnostic pitfalls that may lead to the discrepancy between cytology and histology.
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2012年第4期265-268,共4页
Chinese Journal of Pathology
关键词
宫颈疾病
宫颈肿瘤
宫颈上皮内瘤样病变
细胞学技术
Uterine cervical diseases
Uterine cervical neoplasms
Cervical intraepithelial neoplasia
Cytological techniques
