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目的:探讨薄层液基细胞学技术(TCT)联合第2代杂交捕获乳头状瘤病毒核酸检测(HCII HPV DNA)检测诊断宫颈病变的价值,并总结TCT诊断中漏诊、误诊的原因。方法:收集上海市长宁区中心医院2006—2009年行TCT、HCII HPVDNA检测及阴道镜活检的病例共1050例,分别比较了TCT、HCII HPV DNA及TCT联合HCII HPV DNA检测的诊断效能。对照组织病理学诊断结果,分析了TCT漏诊、误诊的原因。结果:TCT中低度鳞状上皮细胞内病变(LSIL)/高度鳞状上皮细胞内病变(HSIL)与组织学的符合率显著高于未见癌细胞或癌前病变细胞(NILM)/不能明确意义的非典型鳞状上皮细胞(ASUCS),P<0.01;人乳头状瘤病毒(HPV)感染率随病变程度加重而逐步增加(P<0.01);TCT联合HCII HPV DNA检测的敏感性、阴性预测值均显著提高(P<0.01);TCT诊断假阳性的原因主要是对反应性细胞及变性细胞的误诊,而假阴性的原因则是对个别挖空细胞和异形细胞的漏诊。结论:TCT联合HCII HPV DNA检测可以显著提高宫颈病变诊断效能,有助于宫颈癌的早期预防、早期发现、早期治疗。正确的取材、规范的制片、准确的识别反应性细胞、挖空细胞和核深染的异形细胞,将有效地减少假阳性和假阴性率。
Objective: To investigate the value of TCT combined with second generation hybridization to capture HPV DNA for diagnosis of cervical lesions and to summarize the causes of missed diagnosis and misdiagnosis of TCT. Methods: A total of 1050 cases of TCT, HCII HPVDNA test and colposcopy biopsy from 2006 to 2009 were collected from Changning Central Hospital of Shanghai. The diagnostic efficacy of TCT, HCII HPV DNA and TCT combined with HCII HPV DNA testing were compared. According to histopathological diagnosis, the causes of misdiagnosis and misdiagnosis of TCT were analyzed. RESULTS: The coincident rates of LSIL / HSIL with histology in TCT low grade squamous cell were significantly higher than those without or with non-cancerous or precancerous lesion cells (NILM) (ASUCS), P <0.01. The infection rate of human papillomavirus (HPV) gradually increased with the severity of the disease (P <0.01). The sensitivity and negativeness of TCT combined with HCII HPV DNA test (P <0.01). The causes of false positive diagnosis by TCT were mainly misdiagnosis of reactive cells and degenerative cells. The reason of false negative diagnosis was the misdiagnosis of individual hollow cells and abnormal cells. Conclusion: TCT combined with HCII HPV DNA test can significantly improve the diagnostic efficacy of cervical lesions, contribute to the early prevention of cervical cancer, early detection, early treatment. Correct drawing, standardized production, accurate identification of reactive cells, hollow cells and nuclear stained alien cells, will effectively reduce the false positive and false negative rates.