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目的探讨宫颈细胞学诊断在未能除外高度上皮内瘤样病变(内瘤变)的不典型鳞状细胞(ASC-H)的意义和临床处理。方法1999-10-20-2004-01-24墨尔本皇家妇女医院宫颈病变门诊(DysplasiaClinicoftheRoyalWomen’sHospital,Melbourne)对96例宫颈细胞学诊断为ASC-H的患者进行阴道镜检查、阴道镜下活检或行宫颈锥切组织诊断学检查和高危型HPV-DNA测定,分析其结果之间关系。结果96例ASC-H中,87例有组织病理学诊断,58例诊断为宫颈鳞状上皮内瘤变(SIL)占66.6%(58/87),其中高度鳞状上皮内瘤变(HSIL)为44.8%(39/87),低度鳞状上皮内瘤变(LSIL)为21.8%(19/87)。96例行阴道镜检查,78例阴道镜下活检,阴道镜诊断与阴道镜下活检组织学诊断的符合率为64.1%(50/78),45例同时有阴道镜下活检病理和宫颈术后病理,两种方法病理诊断的符合率为73.3%(33/45)。以病理诊断为标准,阴道镜诊断的敏感性是89.4%,特异性是36.8%,阳性预测值是83.1%。32例做了HPV-DNA测定,阳性率为59.4%(19/32),阳性者中68.4%(13/19)经组织学诊断为HSIL。结论宫颈细胞学诊断为ASC-H高度提示宫颈鳞状上皮内瘤变(SIL)的存在。阴道镜检查、阴道镜下活检和高危型HPV-DNA的测定,对ASC-H的处理有重要的指导意义。
Objective To investigate the significance and clinical treatment of cervical cytology in the diagnosis of atypical squamous cells (ASC-H) that have not been able to exclude high grade intraepithelial neoplasia (neoplasia). METHODS: Ninety-six patients diagnosed as ASC-H by cervical cytology were examined by colposcopy on colposcopy. Colposcope biopsy or colposcopy was performed. Cervical conization tissue diagnostic tests and high-risk HPV-DNA determination, analysis of the relationship between the results. Results Of the 96 ASC-H specimens, 87 had histopathological diagnosis and 58 (58.6%) had cervical squamous intraepithelial neoplasia (58/87), of which 58 had high grade squamous intraepithelial neoplasia (HSIL) Was 44.8% (39/87), and low grade squamous intraepithelial neoplasia (LSIL) was 21.8% (19/87). Collected 96 colposcopy, 78 colposcopy biopsy, colposcopy and colposcopy biopsy histological coincidence rate was 64.1% (50/78), 45 cases of both colposcopy biopsy and cervical surgery Pathology, pathological diagnosis of the two methods in line with the rate was 73.3% (33/45). With pathological diagnosis as the standard, the sensitivity of colposcopy was 89.4%, the specificity was 36.8%, and the positive predictive value was 83.1%. 32 cases had HPV-DNA test, the positive rate was 59.4% (19/32), 68.4% (13/19) of the positive were histologically diagnosed as HSIL. Conclusion Cervical cytology diagnosis of ASC-H is highly suggestive of cervical squamous intraepithelial neoplasia (SIL). Colposcopy, colposcopy biopsy and high-risk HPV-DNA determination of ASC-H treatment has important guiding significance.