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目的评价三阶梯技术[液基超薄片细胞电脑扫描系统(TCT)—阴道镜—病理组织学联合应用]在宫颈病变中的应用价值。方法对2005年3月-2007年12月来我院妇科门诊就诊的2295例患者采用TCT检查,细胞学诊断采用TBS分级系统。阳性诊断包括意义不明不典型鳞状上皮(ASCUS)及意义不明不典型腺上皮(AGCUS)以上病变,所有ASCUS及AGCUS以上病变全部在阴道镜下活检。病理组织学阳性诊断包括宫颈上皮内瘤变(CIN)以上病变。结果在宫颈光滑和宫颈糜烂两者中TCT阳性检出率无显著性差异(χ2=2.98,P>0.05)。2295例患者TCT检查阳性者459例,阳性率20%,全部在阴道镜下取活检进行病理组织学检查。ASCUS及AGCUS423例,炎症245例(57.91%),CINΙ120例(28.36%),CINⅡ和CINⅢ57例(13.5%),鳞癌1例(0.2%),阳性符合率42.08%(178/423)。低度鳞状上皮内病变(LSIL)和高度鳞状上皮内病变(HSIL)与病理组织学阳性符合率均为53%。结论TCT为宫颈病变早期筛查的可选方法,与病理组织学有一定的相关性,TCT与阴道镜下定位活检、病理组织学检查联合应用,可提高宫颈病变检出的准确率。
Objective To evaluate the value of three-step technique [combined application of TCT-colposcopy-histopathology] in cervical lesions. Methods A total of 2295 patients who came to our gynecological clinic from March 2005 to December 2007 were examined by TCT and cytology was diagnosed by TBS grading system. Positive diagnosis includes atypical atypical squamous epithelium (ASCUS) and atypical atypical glandular epithelium (AGCUS), all of which are colposcopic biopsies of all lesions above ASCUS and AGCUS. Positive histopathological diagnosis includes cervical intraepithelial neoplasia (CIN) above lesions. Results There was no significant difference in the positive detection rate of TCT between cervical smoothness and cervical erosion (χ2 = 2.98, P> 0.05). Among the 2295 patients, 459 were positive for TCT, the positive rate was 20%. All of them were biopsy under colposcopy for histopathological examination. The positive rate of coincidence was 42.08% (178/423) in 245 cases of ASCUS and AGCUS, 245 cases of inflammation (57.91%), 120 cases of CINI (28.36%), 57 cases of CINⅡ and CINⅢ (13.5%) and 1 case of squamous cell carcinoma (0.2%). Low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) and histopathology positive coincidence rate was 53%. Conclusion TCT is an early screening method for cervical lesions and has some correlation with histopathology. TCT combined with colposcopic biopsy and histopathology can improve the accuracy of cervical lesions detection.