液基细胞学检测和阴道镜在宫颈病变筛查中的应用研究.docVIP

　　液基细胞学检测和阴道镜在宫颈病变筛查中的应用研究 作者：来菊英 朱华洁 邵梅 张海燕 陈丽 【摘要】 目的　探讨液基细胞学检测（TCT）和 电子 阴道镜在子宫颈病变筛查中的诊断价值。方法　对500例妇女行宫颈TCT和阴道镜检查，以活检病 理学 诊断为金标准，对宫颈癌和癌前病变进行筛查，并对结果进行分析。 结果　本组500例妇女中，阴道镜下定位活检病理诊断结果显示：宫颈上皮内瘤变-Ⅰ（CIN-Ⅰ） 39例、CIN-Ⅱ 14例、CIN-Ⅲ 11例、宫颈癌8例。阴道镜发现异常83例，对上皮内瘤变诊断的敏感性93.51％，特异性为97.40％，漏诊率1.00％。宫颈TCT发现异常涂片60例，对CIN的诊断敏感性为58.44％，特异性为96.45％，漏诊率6.40％。联合宫颈TCT和电子阴道镜检查，诊断敏感性为96.10％，特异性为98.82％，漏诊率0.60％。 结论　阴道镜检查对宫颈癌及癌前病变的早期诊断价值优于宫颈TCT，联合宫颈TCT和阴道镜检查可进一步提高宫颈癌及癌前病变的检出率。 【关键词】 阴道镜；　液基细胞学检测；　宫颈上皮内瘤变；　宫颈癌；　活检 Ａｂｓｔｒａｃｔ Ｏｂｊｅｃｔｉｖｅ To investigate the clinical value of liquid based cytology test and colposcopy in the primary screening for cervical lesions. Methods Retrospective analysis ales of the Peoples Hospital of Jianggan District admitted from January, 2007 to December, 2007. All the patients recEived liquid based cytology test and colposcopy in order to screen the cervical lesions. According to the pathological results, the clinical value of liquid based cytology test and colposcopy ong the 500 females, 39 cases ultanEIty, 83 cases ined as cervical intraepithelial neoplasia or cervical cancer by colposcopy, and 60 cases as atypical squamous cells of undetermined significance or above by liquid based cytology test. Among this group of patients, the sensitivity, the specificity and the rate of missing diagnosis of colposcopy in the diagnosis of CIN ore, the sensitivity, the specificity and the rate of missing diagnosis ore effective than liquid based cytology test in the primary screening for cervical lesions. Adjunctive liquid based cytology test can enhance the sensitivity and specificity of the diagnosis of cervical lesions by colposcopy. Ｋｅｙ ｗｏｒｄｓ colposcopy;　liquid based cytology test;　cervical intraepithelial neoplasia;　cervical cancer;　biopsy 临床上常用宫颈液基细胞学检测（thinprep cytology test, TCT）筛查宫颈癌及癌前病变，但宫颈TCT不能确诊宫颈癌及癌前病变，只有通过阴道镜下活检才能明确诊断[1]。阴道镜是介于肉眼和低倍显微镜之间的放大窥镜，经过不断改良，已 发展 有光学和电子数码两大类阴道镜，阴道镜通过放大直接观察宫颈表面血管上皮的形态结构以评估病变，成为宫颈癌和癌前病变筛查的主要手段[2]。本次研究采用宫颈TCT配合阴道镜检查对宫颈癌、癌前病变进行筛查，取得了良好的效果。