中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2012年
4期
265-268
,共4页
李旻%梅平%罗东兰%王小冰%刘艳辉
李旻%梅平%囉東蘭%王小冰%劉豔輝
리민%매평%라동란%왕소빙%류염휘
宫颈疾病%宫颈肿瘤%宫颈上皮内瘤样病变%细胞学技术
宮頸疾病%宮頸腫瘤%宮頸上皮內瘤樣病變%細胞學技術
궁경질병%궁경종류%궁경상피내류양병변%세포학기술
Uterine cervical diseases%Uterine cervical neoplasms%Cervical intraepithelial neoplasia%Cytological techniques
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.
目的 探討影響宮頸液基細胞學高度鱗狀上皮內病變(HSIL)診斷準確性的原因.方法 收集2007至2010年間415例細胞學診斷為HSIL的病例,將細胞學結果與組織學結果對照分析,複查液基細胞學製片及組織學切片,分析誤診原因.結果 共42209例受檢者進行瞭ThinPrep液基細胞學檢查,其中細胞學診斷為HSIL者415例,佔篩查人群的1.0%.HSIL患者的平均年齡41.6歲,30~ 49歲為高髮年齡.325例細胞學診斷為HSIL的病例其組織學診斷結果為:陰性/炎性改變23例(7.1%),宮頸上皮內病變(CIN)1級/人乳頭狀瘤病毒(HPV)感染22例(6.8%),CIN2級/CIN3級223例(68.6%),鱗狀細胞癌(SCC)57例(17.5%).細胞學HSIL對組織學CIN2級及以上病變的暘性預測值為86.2% (280/325),對組織學CIN1級以上病變的暘性預測值為92.9%(302/325).細胞學假暘性的原因主要是組織學取材陰性、細胞學片中齣現反應性腺上皮、孤島狀萎縮及放化療反應等.細胞學診斷為HSIL而組織學診斷為SCC者57例(17.5%),誤診的原因主要為社會因素、對部分低分化SCC的細胞學錶現認識不足,以及細胞學片中缺乏典型癌性特徵.結論 細胞學HSIL對宮頸CIN2級/CIN3級及SCC的暘性預測值較高,但存在與組織學診斷結果不符的情況,細胞學醫師和婦科醫師應註意避免造成不一緻的因素.
목적 탐토영향궁경액기세포학고도린상상피내병변(HSIL)진단준학성적원인.방법 수집2007지2010년간415례세포학진단위HSIL적병례,장세포학결과여조직학결과대조분석,복사액기세포학제편급조직학절편,분석오진원인.결과 공42209례수검자진행료ThinPrep액기세포학검사,기중세포학진단위HSIL자415례,점사사인군적1.0%.HSIL환자적평균년령41.6세,30~ 49세위고발년령.325례세포학진단위HSIL적병례기조직학진단결과위:음성/염성개변23례(7.1%),궁경상피내병변(CIN)1급/인유두상류병독(HPV)감염22례(6.8%),CIN2급/CIN3급223례(68.6%),린상세포암(SCC)57례(17.5%).세포학HSIL대조직학CIN2급급이상병변적양성예측치위86.2% (280/325),대조직학CIN1급이상병변적양성예측치위92.9%(302/325).세포학가양성적원인주요시조직학취재음성、세포학편중출현반응성선상피、고도상위축급방화료반응등.세포학진단위HSIL이조직학진단위SCC자57례(17.5%),오진적원인주요위사회인소、대부분저분화SCC적세포학표현인식불족,이급세포학편중결핍전형암성특정.결론 세포학HSIL대궁경CIN2급/CIN3급급SCC적양성예측치교고,단존재여조직학진단결과불부적정황,세포학의사화부과의사응주의피면조성불일치적인소.
Objective To investigate factors affccting the diagnostic accuracy of cervical liquidbased 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 2007and 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 positivc 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 HSIL had a histological diagnosis of SCC. The possible causes of misdiagnosis were social factors, under-recognized cytological features of poorlydifferentiated 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.