CAJ | 학술논문

目的探讨电脑辅助阅片系统(TIS)在宫颈薄层液基细胞涂片诊断中的价值.方法共收集19 600例液基细胞涂片,其中2011年9月至2012年3月期间9800例经TIS阅片,2010年9月至2011年4月期间9800例经人工阅片作为对照,比较两种阅片方法异常细胞检出率和常见微生物检出率；以阴道镜活检的组织病理学诊断结果作为金标准,比较两种阅片方法诊断的各级病变符合率；比较两种阅片方法的阅片效率.结果 TIS阅片异常细胞检出率为6.8％ (665/9800),较上一年度同期人工阅片检出率(5.4％,525/9800)有提高(P＜0.05),主要是不能明确意义的不典型鳞状上皮细胞(ASCUS)、低度鳞状上皮细胞内病变(LSIL)的检出增加,其他级别病变未见明显提高；比较细胞学诊断与组织病理符合率显示TIS诊断未见癌细胞或癌前病变细胞(NILM)、ASCUS的组织学符合率较人工阅片有提高,其他级别病变两者相近.检出异常细胞假阴性率由8.5％ (17/200)降到0.7％(2/289;P ＜0.01).TIS异常细胞检出的敏感性高于人工阅片,而两者特异性相近.检出微生物感染方面,TIS与人工阅片各有优劣.TIS提高阅片效率达50％.结论 TIS在提高阅片效率的同时增加了异常细胞的检出率,降低了假阴性率.
목적 탐토전뇌보조열편계통(TIS)재궁경박층액기세포도편진단중적개치.방법 공수집19 600례액기세포도편,기중2011년9월지2012년3월기간9800례경TIS열편,2010년9월지2011년4월기간9800례경인공열편작위대조,비교량충열편방법이상세포검출솔화상견미생물검출솔；이음도경활검적조직병이학진단결과작위금표준,비교량충열편방법진단적각급병변부합솔；비교량충열편방법적열편효솔.결과 TIS열편이상세포검출솔위6.8％ (665/9800),교상일년도동기인공열편검출솔(5.4％,525/9800)유제고(P＜0.05),주요시불능명학의의적불전형린상상피세포(ASCUS)、저도린상상피세포내병변(LSIL)적검출증가,기타급별병변미견명현제고；비교세포학진단여조직병리부합솔현시TIS진단미견암세포혹암전병변세포(NILM)、ASCUS적조직학부합솔교인공열편유제고,기타급별병변량자상근.검출이상세포가음성솔유8.5％ (17/200)강도0.7％(2/289;P ＜0.01).TIS이상세포검출적민감성고우인공열편,이량자특이성상근.검출미생물감염방면,TIS여인공열편각유우렬.TIS제고열편효솔체50％.결론 TIS재제고열편효솔적동시증가료이상세포적검출솔,강저료가음성솔.
Objective To investigate the value of computer-assisted slide-screening system (ThinPrep imaging system,TIS) in the diagnosis of cervical Thinprep smears.Methods A total of 19 600 ThinPrep smears were collected,including 9800 slides by TIS-assisted screening from September 2011 to March 2012 and 9800 slides by manual screening from September 2010 to April 2011 as control.The detection rates of abnormal cells and common microbial infection by the different screening methods were compared.With histopathological diagnosis of colposcopic biopsy as the gold standard,the screening efficiency and correlation of cytologic diagnosis among different screening methods were analyzed.Results Compared with manual screening,the detection rate of abnormal cells in 9800 cases by TIS-assisted screen was increased from 5.4％ (525/9800) to 6.8％ (665/9800),mainly in the categories of ASCUS and LSIL (P ＜ 0.05).TIS had a higher accordance rate between cytologic diagnosis and histopathological diagnosis in the NILM and ASCUS than that by manual screening.False-negative rate of finding abnormal cells by TIS decreased from 8.5％ (17/200) to 0.7％ (2/289,P ＜ 0.01) with an increased sensitivity compared to manual screening,althoughthe specificity was similar.Both TIS and manual screening had advantages and disadvantages respectively in the detection of microbial organisms.TIS improved screening efficiency by 50％.Conclusion TIS improves not only the screening efficiency but also the detection of abnormal cells with a reduced false negativity,and it therefore has a broad application prospect.