【摘要】 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。更多还原

【Abstract】 Objective:To investigate the value of thinprep cytologic test(TCT) combined with human papilloma virus(HPV) Hybrid Capture II(HPV HCII) test in cervical intraepithelial neoplasia and summarize the reasons for misinterpreting/missing diagnosis.Methods:Patients(n=1050) with TCT,HCII HPV test and routine biopsy under colposcopy encountered between 2006-2009 in Shanghai Changning District hospital.According to cervical biopsy diagnosis,we analyzed the causes of false-positive and false-negative in TCT diagnosis and compared the diagnostic efficiency among TCT,HCII HPV test,TCT combined with HCII HPV test.Results: The rates of(LSIL/HSIL) accordance with biopsy were higher than(NILM/ASCUS),P<0.01.HPV infection was increased with the degree of cervical lesions(P<0.01).The sensitivity and negative predictive value were significantly higher for TCT combined with HCII HPV DNA than TCT alone(P<0.01).The causes of false-positive in TCT diagnosis were mainly for misinterpreting reactive cells and regressive cells while false-negative were mainly for missing individual koilocyte and dysplastic cell.Conclusions: TCT combined with HCII HPV test evidently enhance diagnostic efficiency which will play a positive role in the early preventation,detection and treatment of cervical carcinoma.False-positive and false-negative will be effectively decreased by means of accurate sampling,regular procession and exact recognization of reactive cell,koilocyte and hyperchromaticly dysplastic cell.更多还原