173例宫颈病变患者TCT检查及病理结果临床分析
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摘要
目的:探讨我院173例可疑宫颈病变患者中液基薄层细胞学检测(TCT)在宫颈病变诊断中的临床意义。方法:将新疆医科大学第一附属医院自2008年6月至2009年9月妇科门诊、住院部病房就诊行妇科检查疑似宫颈病变或体检常规行TCT检查结果提示异常的173例患者,对其年龄、民族、避孕方式、临床症状进行归纳、分析研究的同时,行TCT检查,并与我院行阴道镜下宫颈可疑组织活检或对级别较高者行宫颈锥切术,以阴道镜下病理学检查及宫颈锥切后病理结果做为金标准,分析评价这173例患者中TCT检查的敏感度、特异度及假阴性率、假阳性率,并对不同病理学级别宫颈病变所对应的TCT结果做一临床分析。结果:TCT检测的敏感度为60%,特异度为71.4%,假阴性率为40%,假阳性率为28.6%。随着宫颈组织病理学级别的升高,TCT的阳性率及敏感度分别为48.7%、52.2%、62.1%和89.5%,呈上升趋势。结论:本研究中,随着宫颈组织病理学级别的升高,TCT的敏感度随之升高。TCT与病理诊断有较高的符合率,可作为宫颈病变的一筛查指标,但它仍存在一定的假阴性、假阳性率,不能以此作为判断宫颈病变的依据。
Objective:To study the clinical value of thin-prep-liquid-based cytology tes(tTCT)in the diagnosis of our hospital’s 173 cases of cervical lesions.Methods:173 cases of patients from Junly 2008 to September 2009 in the first Subsidiary of Xin Jiang Medical University were screened by TCT,based on the pathology result as a golden standard,to aspect the sensitivity,specificity and fake negative rate of the TCT Test. Results:The postitive result cases of TCT were 84,the positive result cases of pathlology were 110. The sensitivity of TCT were 60%,the specificity were 71.4%,the fake negative rates were40%,the fake positive rates were 28.6%.In pace with the raise of pathological scalar,the positive result rate of TCT were 48.7%,52.2%,62.1% and 89.5%. Conclusions:In this research,in pace with the raise of pathological scalar,the positive result rate of TCT were become higher and higher,and TCT can be one of cervical lesion screening technology,but it still has the fake negative rates and fake positive rats,it can not be used as a diagnosis foundation of cervical lesion.
Objective:To study the clinical value of thin-prep-liquid-based cytology tes(tTCT)in the diagnosis of our hospital’s 173 cases of cervical lesions.Methods:173 cases of patients from Junly 2008 to September 2009 in the first Subsidiary of Xin Jiang Medical University were screened by TCT,based on the pathology result as a golden standard,to aspect the sensitivity,specificity and fake negative rate of the TCT Test. Results:The postitive result cases of TCT were 84,the positive result cases of pathlology were 110. The sensitivity of TCT were 60%,the specificity were 71.4%,the fake negative rates were40%,the fake positive rates were 28.6%.In pace with the raise of pathological scalar,the positive result rate of TCT were 48.7%,52.2%,62.1% and 89.5%. Conclusions:In this research,in pace with the raise of pathological scalar,the positive result rate of TCT were become higher and higher,and TCT can be one of cervical lesion screening technology,but it still has the fake negative rates and fake positive rats,it can not be used as a diagnosis foundation of cervical lesion.
引文
[1] Renshaw AA, Young NA, Birdsong GG, et a. l Comparison of performance of conventional and ThinPrep gynecologic preparations in the College of American Pathologists Gynecologic Cytology Program [ J]. Arch Pathol Lab Med, 2004, 128 (1) : 17-19.
[2]赵昀,崔淑慧,任丽华,等.细胞学?HPV高危型检测在宫颈病变筛查的应用[J].中国妇产科临床杂志, 2006, 3 (7) : 89-92.
[3]郎景和.迎接子宫颈癌预防的全球挑战与机遇[J].中华妇产科杂志, 2002, 37 (3) : 1291.
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[8] Solomon D, Davey D, Kurman R, et al.The 2001 Bethesda System: terminology for reporting results of cervical cytology[J]. JAMA, 2002, 287: 2114-2119
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[10]杨光华.病理学[M]. 5版.北京:人民卫生出版社, 2001: 275-310.
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[18]Biscotti CV, O 'Brien DL, GeroMA, et a. l Thin-layer Paptestvs. Conventional Pap smear. Analysis of400 splits amples[J]. JReprod Med, 2002, 47: 9-13
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[25]陈碧艳,常正义,蒋木英,等. HPV抗体检测联合细胞学诊断在宫颈病变筛查中的应用广西医科大学学报, 2008, 25 (6) : 933-934.
[26]李百鸥,宋炳文.阴道镜下活检诊断宫颈上皮内瘤变1 038例体会[J].中国医药导报, 2007, 4 (34) : 92-93.
[27]张国楠.宫颈上皮内瘤变的处理指南[J].实用妇产科杂志, 2004, 20 (2) : 71-72.
[28]熊如.电子阴道镜检查对宫颈病变的诊断价值探讨[J].国际医药卫生导报, 2006, 12 (4) : 46-48.
[29]徐爱娣,丁爱华,张惜阴.阴道镜对宫颈疾病诊断的临床价值[J].中国实用妇科与产科杂志, 2001, 17 (12) : 751-754.
[30]牛凤霞,齐向红,李季滨,等.液基薄层细胞学联合阴道镜检查对宫颈癌及癌前病变的早期诊断价值[J].山东医药2008, 48 (41) : 88-90.
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[2]赵昀,崔淑慧,任丽华,等.细胞学?HPV高危型检测在宫颈病变筛查的应用.中国妇产科临床杂志, 2006, 3 (7) : 89-92.
[3] Renshaw AA, Young NA, Birdsong GG, et al Comparison of performance of conventional and ThinPrep gynecologic preparations in the College of American Pathologists Gynecologic Cytology Program . Arch Pathol Lab Med, 2004, 128: 17-22
[4]王旭波,刘巧玲,王琳,等. TBS系统筛查煤矿女工宫颈癌的研究.医学理论与实践, 2003, 16 (12) : 1390-1391.
[5] Solomon D, Davey D, Kurman R, eta. l The 2001 Bethesda System: terminology for reporting results of cervical cytology[J]. JAMA, 2002, 287: 2114-2119.
[6]张培影,徐侠,杨海燕,等HPV16/18型表达和细胞病理学检查与宫颈癌及癌前病变的相关性研究.南京中医药大学学报2009, 25 (1) : 27-30.
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[12]廖光东,张小燕,章文华,等.流式荧光杂交法检测高危型人乳头瘤病毒的临床验证试验.中国医学科学院学报, 2007, 29 (5) : 603-607.
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[2]赵昀,崔淑慧,任丽华,等.细胞学?HPV高危型检测在宫颈病变筛查的应用[J].中国妇产科临床杂志, 2006, 3 (7) : 89-92.
[3]郎景和.迎接子宫颈癌预防的全球挑战与机遇[J].中华妇产科杂志, 2002, 37 (3) : 1291.
[4]丰有吉,沈铿.妇产科学[M].北京:人民卫生出版社, 2005: 316-317.
[5] Nance KV. Evolution of Pap testing at a community hospital a ten year experience[ J]. Diagn Cytopathol, 2007, 35: 148-153
[6]孙丽娟.宫颈癌筛查的必要性[J].中国现代医药杂志, 2009, 9, 11 (2) : 106-107
[7]王旭波,刘巧玲,王琳,等. TBS系统筛查煤矿女工宫颈癌的研究[J].医学理论与实践, 2003, 16 (12) : 1390-1391.
[8] Solomon D, Davey D, Kurman R, et al.The 2001 Bethesda System: terminology for reporting results of cervical cytology[J]. JAMA, 2002, 287: 2114-2119
[9]熊如.电子阴道镜检查对宫颈病变的诊断价值探讨[J].国际医药卫生导报, 2006, 12 (4) : 46-48.
[10]杨光华.病理学[M]. 5版.北京:人民卫生出版社, 2001: 275-310.
[11]朗景和.迎接子宫颈癌预防的全球挑战与机遇[J].中华妇产科杂志, 2002, 37: 1-2
[12]赵方辉,戎寿德,乔友林.宫颈癌及其癌前病变筛查方法现状[J].中国医学科学院学报, 2001, 23: 638-64
[13]Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002[J]. CA Cancer J Clin, 2005, 55: 74-108
[14]Renshaw AA, Young NA, Birdsong GG, et al. Comparison of performance of conventional and ThinPrep gynecologic preparations in the College of American Pathologists Gynecologic Cytology Program [ J]. Arch Pathol Lab Med, 2004, 128: 17-22
[15]戎寿德,陈汶,吴令英,等.山西省襄垣县宫颈癌危险因素分析[J].中华预防医学杂志, 2002, 36 (1) : 41-43.
[16]高天杨,王秋艳,文爽.宫颈癌患者年轻化与人乳头瘤病毒感染增加的关系[J].黑龙江医学, 2008, 32 (3) : 170-172
[17]杨莉,钱宁,莫宝庆. 264例子宫颈高危型人乳头瘤病毒检测结果及分析[J].江苏医药, 2009, 35 (1) : 110-111.
[18]Biscotti CV, O 'Brien DL, GeroMA, et a. l Thin-layer Paptestvs. Conventional Pap smear. Analysis of400 splits amples[J]. JReprod Med, 2002, 47: 9-13
[19]Abulafia O, Pezzullo JC, Sherer DM. Performance of Thin-Prep-liquid-based cervical cytology in comparison with conventionally prepared Papanicolaou smears: a quantitative survey[J]. Gynecol Oncol, 2003, 90: 137-144
[20]Ferenczy A, Franco E. Cervical-cancer screening beyond the year 2000[J]. Lancet Oncol ,2001, 2: 27-32
[21]Kuhn L, Denny L, Pollack A, et al. Human papillomavirus DNA testing for cervical cancer screening in low-resource settings[J]. Natl Cancer Inst, 2000, 92 (2) : 818-822.
[22]Seung HS, Jaek L, Oye SS. The relationship between cytokines and HPV 216, HPV 216 E6, E7 and high risk HPV viral load in the uterine cervix[J]. Gynecol Oncol, 2007, 104 (3) : 732-738
[23]Tsai HJ, Wu CH, Lai HL, et al. Association between quantitative high-risk human papillomavirus DNA load and cervical intraepithelial neoplasm risk[J]. Cancer Epidemiol Biomarkers Prev, 2005, 14 (11) : 2544-2549.
[24]张培影,徐侠,杨海燕,等. HPV16/18型表达和细胞病理学检查与宫颈癌及癌前病变的相关性研究[J].南京中医药大学学报2009, 25 (1) : 27-30.
[25]陈碧艳,常正义,蒋木英,等. HPV抗体检测联合细胞学诊断在宫颈病变筛查中的应用广西医科大学学报, 2008, 25 (6) : 933-934.
[26]李百鸥,宋炳文.阴道镜下活检诊断宫颈上皮内瘤变1 038例体会[J].中国医药导报, 2007, 4 (34) : 92-93.
[27]张国楠.宫颈上皮内瘤变的处理指南[J].实用妇产科杂志, 2004, 20 (2) : 71-72.
[28]熊如.电子阴道镜检查对宫颈病变的诊断价值探讨[J].国际医药卫生导报, 2006, 12 (4) : 46-48.
[29]徐爱娣,丁爱华,张惜阴.阴道镜对宫颈疾病诊断的临床价值[J].中国实用妇科与产科杂志, 2001, 17 (12) : 751-754.
[30]牛凤霞,齐向红,李季滨,等.液基薄层细胞学联合阴道镜检查对宫颈癌及癌前病变的早期诊断价值[J].山东医药2008, 48 (41) : 88-90.
[1] Renshaw AA, Young Na, Birdsong GG, et al. Comparison of porfarmance of conventional and Thin prep gynecolgic preparation in the college of American pathological Gynecologic Cytology Program. Arch Pathol Lab Med, 2004, 128 (1) : 17-19.
[2]赵昀,崔淑慧,任丽华,等.细胞学?HPV高危型检测在宫颈病变筛查的应用.中国妇产科临床杂志, 2006, 3 (7) : 89-92.
[3] Renshaw AA, Young NA, Birdsong GG, et al Comparison of performance of conventional and ThinPrep gynecologic preparations in the College of American Pathologists Gynecologic Cytology Program . Arch Pathol Lab Med, 2004, 128: 17-22
[4]王旭波,刘巧玲,王琳,等. TBS系统筛查煤矿女工宫颈癌的研究.医学理论与实践, 2003, 16 (12) : 1390-1391.
[5] Solomon D, Davey D, Kurman R, eta. l The 2001 Bethesda System: terminology for reporting results of cervical cytology[J]. JAMA, 2002, 287: 2114-2119.
[6]张培影,徐侠,杨海燕,等HPV16/18型表达和细胞病理学检查与宫颈癌及癌前病变的相关性研究.南京中医药大学学报2009, 25 (1) : 27-30.
[7] Roden R, Wu TC. How will HPV vaccines affect cervical cancer. Nature Rev, 2006, (6) 753-763.
[8] Scheurer ME, Tortolero LG, Adler SK. Human papillo mavirus infection: biology, epidemiology, and prevention. In Gynecol Cancer, 2005, 15 (5) : 727-746.
[9] Kuhn L, Denny L, Pollack A, et al. Human papillomavirus DNA testing for cervicalcancer screening in low-resource set-tings. Natl Cancer Inst, 2000, 92 (2) : 818-822.
[10]Hamada K, Shirakawa T. Adenovirus-mediated transfer of human papillomavirus 16 E6 /E7 antisense RNA and induction of apoptosis incervical cancer. Cell Biochem, 2007, 100 (5) : 1191.
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