关键词: TCT, 宫颈上皮内瘤样病变, 宫颈癌, 人乳头瘤病毒

Abstract: Objective To study the clinical value of liquid based cytology test compared with vaginoscopy histology in the diagnosis of cervical lesion.Methods Retrospective analysis was carried out in 6 621 females(age range from 21 to 73 years old) from a single centre(Beijing Friendship Hospital) admitted from May, 2006 to October, 2006. All the patients received liquid based cytology test(Thin Prep Pap Test, TCT) and the result was reported in terms of the Bethesda system(TBS system). Among all the patients, 253 of them were diagnosed as atypical squamous cells of undetermined significance(ASC-US) or above and should receive further vaginoscopy biopsy test.Results Among the 253 patients with abnormal TCT results, 180 cases were diagnosed as ASC-US, 7 cases as atypical gland cells of undetermined significance(AGUS), 46 cases as low grade squamous intraepithelial lesions(LSIL), 17 cases as atypical squamous cells cannot exclude high grade intraepithelial lesion(ASC-H) and 3 cases as high grade squamous intraepithelial lesions(HSIL). All the TCT results of the above 253 patients were compared with the histological results from vaginoscopy biopsy. 1) Among the 180 ASC-S cases, after biopsy test, 37 cases were diagnosed as stage one cervical intraepithelial neoplasia(CIN Ⅰ), 13 cases as CIN Ⅱ and 1 case as CIN Ⅲ. 2) Among the 7 cases of AGUS, one case was confirmed as CIN Ⅰ after biopsy. 3) Among the 46 cases of LSIL, further biopsy test showed that 18 cases of them were CIN Ⅰ, 1 case was CIN Ⅱ, 1 case was CIN Ⅲ and 2 cases were invasive squamous cancer. 4) Among the 17 cases of ASC-H, 2 cases were diagnosed as CIN Ⅱ, 3 cases as CIN Ⅲ and 2 cases of in-situ squamous cancer after biopsy. 5) All the 3 cases who were diagnosed as HSIL by TCT were confirmed to have cancer after histological exam by vaginoscopy biopsy. Two of them were invasive squamous cancer and the other one was well-differentiated adenocarcinoma. Human papilloma virus(HPV) DNA was detected in both samples obtained by the 2 methods of TCT and vaginoscopy biopsy. Sixty patients showed HPV-DNA positive from TCT(27.7%) but 82 patients showed HPV-DNA positive from the biopsy(32.4%). The positive screening rate of HPV by the above 2 methods was compared by means of χ² exam and statistical difference was found between the 2 methods(P=0.03).Conclusion Adjunctive TCT can enhance the sensitivity and accuracy of the diagnosis of cervical leision by vaginoscopy and biopsy. In clinical practice, ASCUS usually need to recheck after 3～6 months.However this reseach shows: that carrying out vaginoscopy and biopsy as early as possible can earn much opportunity to diagnose cervical cancer early.

Key words: thin prep liquid based cytology testing, cervical intraepithelial neoplasia, cervical cancer, human papilloma virus