阴道镜联合基液细胞监测技术筛查宫颈癌前病变的价值

作者:未知

  [摘要]目的 探討阴道镜联合基液细胞监测技术筛查宫颈癌前病变的价值。方法 收集2018年1~8月来我院就诊且行宫颈/阴道细胞学筛查患者9261例,采集其标本,并对结果异常者行阴道镜检查及多点活检组织病理学检查。以宫颈病理学检查为标准,统计阴道镜联合基液细胞监测结果与病理检查结果的符合率。结果 基液细胞学宫颈癌筛查标本9261例,正常范围内8883例(95.9%),异常涂片378例(4.1%);异常涂片378例中,非典型鳞状细胞(ASC)+非典型腺细胞(AGC)189例(50.0%),鳞状上皮细胞内低度病变(LSIL)119例(31.5%),鳞状上皮细胞内高度病变(HSIL)49例(13.0%),鳞状细胞癌(SCC)21例(5.5%)。阴道镜联合基液细胞阳性与病理学检查的总符合率为50.0%,其中ASC+AGC、LSIL、HSIL、SCC诊断符合率分别为29.6%、52.9%、85.7%、100.0%。阴道镜联合基液细胞监测下,ASC+AGC及LSIL与宫颈病理学检查的符合率比较,差异有统计学意义(χ2=8.014,P<0.05);HSIL及SCC与宫颈病理学检查的符合率比较,差异无统计学意义(χ2=0.875,P>0.05)。结论 阴道镜联合基液细胞监测技术筛查宫颈癌前病变,方法可靠,与病理结果符合率高,可联合推广应用。
  [关键词]基液细胞监测;阴道镜;宫颈癌前病变
  [中图分类号] R711.74 [文献标识码] A [文章编号] 1674-4721(2019)5(b)-0073-03
  Value of colposcopy combined with basal fluid cell monitoring technique in screening cervical precancerous lesions
  LIU Ming ZHANG Gui-Ping
  Department of Gynecology, the Affiliated Hospital of Qingdao University, Shandong Province, Qingdao 266000, China
  [Abstract] Objective To explore the value of colposcopy combined with basal fluid cell monitoring technique in screening cervical precancerous lesions. Methods A total of 9261 patients who underwent cervical/vaginal cytology screening in our hospital from January to August 2018 were enrolled. The specimens were collected and colposcopy and multi-point biopsy were performed on the abnormalities. According to the cervical pathological examination, the coincidence rate between the results of colposcopy combined with basal fluid cell monitoring and pathological examination was calculated. Results There were 9261 cases of cervical cancer screening specimens from basal fluid cytology, in which 8883 cases (95.9%) were in the normal range, and 378 cases (4.1%) were abnormal smears. Among 378 cases of abnormal smears, 189 cases (50.0%) were atypical squamous cells (ASC)+atypical glandular cells (AGC), 119 cases (31.5%) were low-grade lesions in squamous intraepithelial cells (LSIL), 49 cases (13.0%) were high-grade lesion in squamous epithelial cells (HSIL), and 21 cases (5.5%) were squamous cell carcinoma (SCC). The total coincidence rate of colposcopy combined with basal cell positive and pathological examination was 50.0%, among which the diagnostic coincidence rate of ASC+AGC, LSIL, HSIL and SCC was 29.6%, 52.9%, 85.7% and 100.0%, respectively. Under the colposcopy combined with basal fluid cell monitoring, the coincidence rate of ASC+AGC and LSIL with cervical pathology was statistically significant (χ2=8.014, P<0.05). There was no significant difference in the coincidence rate between HSIL and SCC and cervical pathology (χ2=0.875, P>0.05). Conclusion Colposcopy combined with basal fluid cell monitoring technology is a reliable method in screening cervical precancerous lesions, and the coincidence rate with pathological results is high, which can be jointly promoted and applied.   [Key words] Basal fluid cell monitoring; Colposcopy; Cervical precancerous lesions
  宫颈癌在妇女全部肿瘤中的占比约为15%,位居世界第2位,是僅次于乳腺癌的女性恶性肿瘤,近年来发病率上升明显且其趋势呈年轻化[1-3],早期筛查对于疾病诊疗及治愈尤为重要。宫颈癌作为人乳头瘤病毒感染性疾病的一种,是目前唯一能够预防并治愈的癌症。传统的巴氏涂片筛查宫颈癌虽然在降低宫颈癌病死率方面检出率较高,但其假阴性率往往会明显升高。近年来,随着基液细胞监测检测技术以及阴道镜的不断快速进步,宫颈癌前病变的筛查质量和瘤变检出效率明显提高[4]。基液细胞检测技术较传统操作更为高效,在保存全部标本的基础上,采用自动化制片,减低细胞过度干燥而带来的假阳性。
  为更好地规范宫颈癌前病变的筛查工作,现将我院妇科门诊9261例妇女宫颈病变筛查情况进行报道,旨在为宫颈癌早发现、早诊断、早治疗提供参考,降低妇科疾病中宫颈癌变的发展进程及病死率。
  1资料与方法
  1.1一般资料
  收集2018年1~8月来我院妇科门诊就诊且需行宫颈/阴道细胞学筛查的妇科疾病患者9261例,年龄22~61岁,平均(48±11)岁。所有患者均有性生活2年以上,且未曾参加过宫颈病变筛查,无子宫相关疾病病史,无精神系统疾病,无抽烟、酗酒史。患者均知情同意,本研究经医院医学伦理委员会审核批准。
  1.2方法
  1.2.1标本的采集 充分暴露宫颈,用消毒棉球擦净宫颈口周围的分泌物,将基液细胞刷插入宫颈管内1 cm左右,顺时针旋转3圈,取宫颈表面、宫颈管及宫颈移行带的细胞,然后将刷头取下置入细胞保存液中,将标本密封,后进行制片、阅片。
  1.2.2基液细胞诊断方法 采用2001年国际癌症协会巴氏系统分类法[5],对结果异常者行阴道镜检查。
  (1)正常范围(未见上皮内病变、反应性细胞改变)。
  (2)鳞状上皮细胞异常:①未明确诊断意义的非典型鳞状细胞(atypical squamous cell,ASC);②鳞状上皮细胞内低度病变(low-grade lesion in squamous epithelial cells,LSIL);③鳞状上皮细胞内高度病变(high-grade lesion in squamous epithelial cells,HSIL);④鳞状细胞癌(squamous cell carcinoma,SCC);⑤非典型腺细胞(atypical glandular cells,AGC)。
  (3)腺细胞异常:①未明确诊断意义的不典型腺细胞(atypical glandular cell of undetermined significance,AGUS);②宫颈管原位癌(carcinoma in situ,AIS);③腺癌。
  鳞状上皮细胞异常或腺细胞异常均诊断为基液细胞学阳性。
  1.2.3宫颈病理活检 对细胞学诊断为阳性的病例进行二级筛查,采用阴道镜检查并在可疑病变部位予以活检,阴道镜见正常转化区者予3,6,9,12四点活检。病理诊断包括炎症或正常、宫颈上皮内病变(cervical intraepithelial neoplasia,CIN Ⅰ、Ⅱ、Ⅲ)、癌[6]。
  1.3评价标准
  以宫颈病理学检查为标准,统计阴道镜联合基液细胞监测结果与病理检查结果的符合率。
  1.4统计学方法
  采用SPSS 18.0统计学软件进行数据分析,计数资料采用率表示,组间比较采用χ2检验,以P<0.05为差异有统计学意义。
  2结果
  2.1基液细胞学检查结果
  基液细胞学宫颈癌筛查标本9261例,正常范围内8883例(95.9%),异常涂片378例(4.1%);异常涂片378例中,ASC+AGC 189例(50.0%),LSIL 119例(31.5%),HSIL 49例(13.0%),SCC 21例(5.5%)。
  2.2阴道镜联合基液细胞学阳性结果与病理学检查结果
  阴道镜联合基液细胞阳性与病理学检查的总符合率为50.0%,其中ASC+AGC、LSIL、HSIL、SCC诊断符合率分别为29.6%、52.9%、85.7%、100.0%(表1)。阴道镜联合基液细胞监测下,ASC+AGC及LSIL与宫颈病理学检查的符合率比较,差异有统计学意义(χ2=8.014,P<0.05);HSIL及SCC与宫颈病理学检查的符合率比较,差异无统计学意义(χ2=0.875,P>0.05)。
  3讨论
  宫颈癌作为人乳头瘤病毒感染性疾病的一种,病因明确,是目前唯一能够预防并治愈的癌症[7-8]。宫颈癌的发生及发展是一个较为漫长的过程,宫颈病变从CIN到宫颈浸润癌是一个量变引发质变的不间断发展过程[9]。经组织学活检确诊的CIN,发展为浸润癌需10年左右[10],因此对宫颈病变患者定期进行筛查,及早发现,可作为减缓宫颈浸润癌发展,降低宫颈癌发病率的主要方式。
  传统的巴氏涂片筛查宫颈癌虽然在降低宫颈癌病死率方面的检出率较高,但其假阴性率往往比较高,达50%~90%[11]。本研究采用基液细胞监测技术对于宫颈病变阳性患者进行阴道镜检查,进一步确定了病变部位,结果显示,其阳性结果与宫颈组织病理检查符合率,ASC+AGC为29.6%,LSIL为52.9%,HSIL为85.7%,SCC为100.0%,提示基液细胞学检测技术对宫颈高度病变者的检测符合率高。另外,ASC+AGC及LSIL与宫颈病理学检查的符合率比较,差异有统计学意义(P<0.05),对于临床具有指导性意义。分析原因为基液细胞检测技术在传统操作的基础上有所改进,采用液体储存宫颈细胞的方式,标本取出后会全部放在细胞保存液中[12-15],取材器上的全部标本几乎全被保存,提高了标本利用率,同时采用自动化制片,也降低了巴氏涂片操作带来的细胞过度干燥的假象发生率,显著提升宫颈异常细胞的阳性诊断率。   综上所述,阴道镜联合基液细胞监测技术筛查宫颈癌前病变,方法可靠,与病理结果符合率高,可联合推广应用。
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  (收稿日期:2019-01-23 本文编辑:任秀兰)
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