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陰道鏡聯(lián)合基液細(xì)胞監(jiān)測(cè)技術(shù)篩查宮頸癌前病變的價(jià)值

2019-06-20 10:21劉鳴張桂萍
中國(guó)當(dāng)代醫(yī)藥 2019年14期
關(guān)鍵詞:宮頸癌前病變陰道鏡

劉鳴 張桂萍

[摘要]目的 探討陰道鏡聯(lián)合基液細(xì)胞監(jiān)測(cè)技術(shù)篩查宮頸癌前病變的價(jià)值。方法 收集2018年1~8月來我院就診且行宮頸/陰道細(xì)胞學(xué)篩查患者9261例,采集其標(biāo)本,并對(duì)結(jié)果異常者行陰道鏡檢查及多點(diǎn)活檢組織病理學(xué)檢查。以宮頸病理學(xué)檢查為標(biāo)準(zhǔn),統(tǒng)計(jì)陰道鏡聯(lián)合基液細(xì)胞監(jiān)測(cè)結(jié)果與病理檢查結(jié)果的符合率。結(jié)果 基液細(xì)胞學(xué)宮頸癌篩查標(biāo)本9261例,正常范圍內(nèi)8883例(95.9%),異常涂片378例(4.1%);異常涂片378例中,非典型鱗狀細(xì)胞(ASC)+非典型腺細(xì)胞(AGC)189例(50.0%),鱗狀上皮細(xì)胞內(nèi)低度病變(LSIL)119例(31.5%),鱗狀上皮細(xì)胞內(nèi)高度病變(HSIL)49例(13.0%),鱗狀細(xì)胞癌(SCC)21例(5.5%)。陰道鏡聯(lián)合基液細(xì)胞陽性與病理學(xué)檢查的總符合率為50.0%,其中ASC+AGC、LSIL、HSIL、SCC診斷符合率分別為29.6%、52.9%、85.7%、100.0%。陰道鏡聯(lián)合基液細(xì)胞監(jiān)測(cè)下,ASC+AGC及LSIL與宮頸病理學(xué)檢查的符合率比較,差異有統(tǒng)計(jì)學(xué)意義(χ2=8.014,P<0.05);HSIL及SCC與宮頸病理學(xué)檢查的符合率比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.875,P>0.05)。結(jié)論 陰道鏡聯(lián)合基液細(xì)胞監(jiān)測(cè)技術(shù)篩查宮頸癌前病變,方法可靠,與病理結(jié)果符合率高,可聯(lián)合推廣應(yīng)用。

[關(guān)鍵詞]基液細(xì)胞監(jiān)測(cè);陰道鏡;宮頸癌前病變

[中圖分類號(hào)] R711.74 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 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

宮頸癌在婦女全部腫瘤中的占比約為15%,位居世界第2位,是僅次于乳腺癌的女性惡性腫瘤,近年來發(fā)病率上升明顯且其趨勢(shì)呈年輕化[1-3],早期篩查對(duì)于疾病診療及治愈尤為重要。宮頸癌作為人乳頭瘤病毒感染性疾病的一種,是目前唯一能夠預(yù)防并治愈的癌癥。傳統(tǒng)的巴氏涂片篩查宮頸癌雖然在降低宮頸癌病死率方面檢出率較高,但其假陰性率往往會(huì)明顯升高。近年來,隨著基液細(xì)胞監(jiān)測(cè)檢測(cè)技術(shù)以及陰道鏡的不斷快速進(jìn)步,宮頸癌前病變的篩查質(zhì)量和瘤變檢出效率明顯提高[4]。基液細(xì)胞檢測(cè)技術(shù)較傳統(tǒng)操作更為高效,在保存全部標(biāo)本的基礎(chǔ)上,采用自動(dòng)化制片,減低細(xì)胞過度干燥而帶來的假陽性。

為更好地規(guī)范宮頸癌前病變的篩查工作,現(xiàn)將我院婦科門診9261例婦女宮頸病變篩查情況進(jìn)行報(bào)道,旨在為宮頸癌早發(fā)現(xiàn)、早診斷、早治療提供參考,降低婦科疾病中宮頸癌變的發(fā)展進(jìn)程及病死率。

1資料與方法

1.1一般資料

收集2018年1~8月來我院婦科門診就診且需行宮頸/陰道細(xì)胞學(xué)篩查的婦科疾病患者9261例,年齡22~61歲,平均(48±11)歲。所有患者均有性生活2年以上,且未曾參加過宮頸病變篩查,無子宮相關(guān)疾病病史,無精神系統(tǒng)疾病,無抽煙、酗酒史。患者均知情同意,本研究經(jīng)醫(yī)院醫(yī)學(xué)倫理委員會(huì)審核批準(zhǔn)。

1.2方法

1.2.1標(biāo)本的采集 充分暴露宮頸,用消毒棉球擦凈宮頸口周圍的分泌物,將基液細(xì)胞刷插入宮頸管內(nèi)1 cm左右,順時(shí)針旋轉(zhuǎn)3圈,取宮頸表面、宮頸管及宮頸移行帶的細(xì)胞,然后將刷頭取下置入細(xì)胞保存液中,將標(biāo)本密封,后進(jìn)行制片、閱片。

1.2.2基液細(xì)胞診斷方法 采用2001年國(guó)際癌癥協(xié)會(huì)巴氏系統(tǒng)分類法[5],對(duì)結(jié)果異常者行陰道鏡檢查。

(1)正常范圍(未見上皮內(nèi)病變、反應(yīng)性細(xì)胞改變)。

(2)鱗狀上皮細(xì)胞異常:①未明確診斷意義的非典型鱗狀細(xì)胞(atypical squamous cell,ASC);②鱗狀上皮細(xì)胞內(nèi)低度病變(low-grade lesion in squamous epithelial cells,LSIL);③鱗狀上皮細(xì)胞內(nèi)高度病變(high-grade lesion in squamous epithelial cells,HSIL);④鱗狀細(xì)胞癌(squamous cell carcinoma,SCC);⑤非典型腺細(xì)胞(atypical glandular cells,AGC)。

(3)腺細(xì)胞異常:①未明確診斷意義的不典型腺細(xì)胞(atypical glandular cell of undetermined significance,AGUS);②宮頸管原位癌(carcinoma in situ,AIS);③腺癌。

鱗狀上皮細(xì)胞異?;蛳偌?xì)胞異常均診斷為基液細(xì)胞學(xué)陽性。

1.2.3宮頸病理活檢 對(duì)細(xì)胞學(xué)診斷為陽性的病例進(jìn)行二級(jí)篩查,采用陰道鏡檢查并在可疑病變部位予以活檢,陰道鏡見正常轉(zhuǎn)化區(qū)者予3,6,9,12四點(diǎn)活檢。病理診斷包括炎癥或正常、宮頸上皮內(nèi)病變(cervical intraepithelial neoplasia,CIN Ⅰ、Ⅱ、Ⅲ)、癌[6]。

1.3評(píng)價(jià)標(biāo)準(zhǔn)

以宮頸病理學(xué)檢查為標(biāo)準(zhǔn),統(tǒng)計(jì)陰道鏡聯(lián)合基液細(xì)胞監(jiān)測(cè)結(jié)果與病理檢查結(jié)果的符合率。

1.4統(tǒng)計(jì)學(xué)方法

采用SPSS 18.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析,計(jì)數(shù)資料采用率表示,組間比較采用χ2檢驗(yàn),以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

2結(jié)果

2.1基液細(xì)胞學(xué)檢查結(jié)果

基液細(xì)胞學(xué)宮頸癌篩查標(biāo)本9261例,正常范圍內(nèi)8883例(95.9%),異常涂片378例(4.1%);異常涂片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陰道鏡聯(lián)合基液細(xì)胞學(xué)陽性結(jié)果與病理學(xué)檢查結(jié)果

陰道鏡聯(lián)合基液細(xì)胞陽性與病理學(xué)檢查的總符合率為50.0%,其中ASC+AGC、LSIL、HSIL、SCC診斷符合率分別為29.6%、52.9%、85.7%、100.0%(表1)。陰道鏡聯(lián)合基液細(xì)胞監(jiān)測(cè)下,ASC+AGC及LSIL與宮頸病理學(xué)檢查的符合率比較,差異有統(tǒng)計(jì)學(xué)意義(χ2=8.014,P<0.05);HSIL及SCC與宮頸病理學(xué)檢查的符合率比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.875,P>0.05)。

3討論

宮頸癌作為人乳頭瘤病毒感染性疾病的一種,病因明確,是目前唯一能夠預(yù)防并治愈的癌癥[7-8]。宮頸癌的發(fā)生及發(fā)展是一個(gè)較為漫長(zhǎng)的過程,宮頸病變從CIN到宮頸浸潤(rùn)癌是一個(gè)量變引發(fā)質(zhì)變的不間斷發(fā)展過程[9]。經(jīng)組織學(xué)活檢確診的CIN,發(fā)展為浸潤(rùn)癌需10年左右[10],因此對(duì)宮頸病變患者定期進(jìn)行篩查,及早發(fā)現(xiàn),可作為減緩宮頸浸潤(rùn)癌發(fā)展,降低宮頸癌發(fā)病率的主要方式。

傳統(tǒng)的巴氏涂片篩查宮頸癌雖然在降低宮頸癌病死率方面的檢出率較高,但其假陰性率往往比較高,達(dá)50%~90%[11]。本研究采用基液細(xì)胞監(jiān)測(cè)技術(shù)對(duì)于宮頸病變陽性患者進(jìn)行陰道鏡檢查,進(jìn)一步確定了病變部位,結(jié)果顯示,其陽性結(jié)果與宮頸組織病理檢查符合率,ASC+AGC為29.6%,LSIL為52.9%,HSIL為85.7%,SCC為100.0%,提示基液細(xì)胞學(xué)檢測(cè)技術(shù)對(duì)宮頸高度病變者的檢測(cè)符合率高。另外,ASC+AGC及LSIL與宮頸病理學(xué)檢查的符合率比較,差異有統(tǒng)計(jì)學(xué)意義(P<0.05),對(duì)于臨床具有指導(dǎo)性意義。分析原因?yàn)榛杭?xì)胞檢測(cè)技術(shù)在傳統(tǒng)操作的基礎(chǔ)上有所改進(jìn),采用液體儲(chǔ)存宮頸細(xì)胞的方式,標(biāo)本取出后會(huì)全部放在細(xì)胞保存液中[12-15],取材器上的全部標(biāo)本幾乎全被保存,提高了標(biāo)本利用率,同時(shí)采用自動(dòng)化制片,也降低了巴氏涂片操作帶來的細(xì)胞過度干燥的假象發(fā)生率,顯著提升宮頸異常細(xì)胞的陽性診斷率。

綜上所述,陰道鏡聯(lián)合基液細(xì)胞監(jiān)測(cè)技術(shù)篩查宮頸癌前病變,方法可靠,與病理結(jié)果符合率高,可聯(lián)合推廣應(yīng)用。

[參考文獻(xiàn)]

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[2]季雯婷,樓微華,洪祖蓓,等.陰道鏡下宮頸活檢的準(zhǔn)確性及宮頸癌漏診相關(guān)因素分析[J].實(shí)用婦產(chǎn)科雜志,2017, 33(4):277-280.

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[4]Khattab R,McMeekin E,Taege AJ,et al.Unsatisfactory exfoliative anal cytology samples,15-year experience with histologic,cytologic,and molecular follow-up[J].Diagn Cytopathol,2018,46(2):117-121.

[5]劉樹范.淺析巴氏五級(jí)分類法與TBS描述性診斷報(bào)告方式[J].中國(guó)實(shí)用婦科與產(chǎn)科雜志,2003,19(3):135-137.

[6]彭蘭芝.宮頸上皮內(nèi)瘤變的命名分類病理及轉(zhuǎn)歸[J].中國(guó)實(shí)用婦科與產(chǎn)科雜志,2003,19(8):454-456.

[7]Denny L.Cervical cancer:prevention and treatment[J].Discov Med,2012,14(75):125-131.

[8]胡詩(shī)淇,楊雨靜,趙霞,等.HPV檢測(cè)獨(dú)立應(yīng)用于宮頸癌篩查長(zhǎng)期預(yù)測(cè)價(jià)值的Meta分析[J].實(shí)用婦產(chǎn)科雜志,2018, 34(5):371-376.

[9]Tsikouras P,Zervoudis S,Manav B,et al.Cervical cancer:screening,diagnosis and staging[J].J BUON,2016,21(2):320-325.

[10]Bava SV,Thulasidasan AK,Sreekanth CN,et al.Cervical cancer:a comprehensive approach towards extermination[J].Ann Med,2016,48(3):149-161.

[11]玉環(huán).巴氏涂片和液基細(xì)胞學(xué)宮頸檢查結(jié)果的臨床分析[J].中國(guó)生化藥物雜志,2017,37(6):383-384.

[12]Liu Y,Zhang L,Zhao G,et al.The clinical research of thinprep cytology test (TCT)combined with HPV-DNA detection in screening cervical cancer[J].Cell Mol Biol,2017,63(2):92-95.

[13]許劍利,徐克惠.高危型HPV檢測(cè)及TCT檢查在宮頸癌篩查中的應(yīng)用分析[J].實(shí)用婦產(chǎn)科雜志,2014,30(12):946-949.

[14]Shi YH,Wang BW,Tuokan T,et al.Association between micronucleus frequency and cervical intraepithelial neoplasia grade in Thinprep cytological test and its significance[J].Int J Clin Exp Pathol,2015,8(7):8426-8432.

[15]韋小丹,歐惠萍,周中,等.廣西地區(qū)健康體檢人群液基薄層細(xì)胞學(xué)篩查宮頸病變的價(jià)值研究[J].中國(guó)性科學(xué),2018,27(3):57-59.

(收稿日期:2019-01-23 本文編輯:任秀蘭)

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