薄层液基细胞学在宫颈癌及其癌前病变筛查中的价值

目的：评价薄层液基细胞学（Thin prep cytology test,TcT）检测技术对宫颈癌前病变的诊断和宫颈癌筛查的准确性及临床价值。方法：收集分析2009年5月～2010年11月在我院妇科门诊行TCT检查的受检者7340例,以细胞学诊断为未明确意义的不典型鳞状上皮细胞（ASC—US）及以上者为阳性结果,并对阳性结果行病理组织学诊断,以组织学诊断作为金标准、,结果：液基细胞学标本满意度高,对SCC、HSIL、LSIL的准确率分别为76．8％、97.3％、100％。结论：TCT结合TBS诊断系统是目前诊断宫颈癌前病变和筛查宫颈癌的理想方法川,同时也可以作为一项宫颈癌术后随访的检测指标。ASC—US患者中存在部分年轻的高危癌前病变者。     

薄层液基细胞学检测及HPV检测对宫颈癌筛查价值的系统评价

目的：系统评价薄层液基细胞学检查（TCT）及人类乳头状病毒（HPV）检查在子宫颈癌筛查中的应用价值。方法：检索收集2000年以来,Cochrane数据库、Pubmed、MEDLINE、Webofscience、EMBASE、万方数据库、清华同方数据库、维普数据库中与TCT及HPv检测在宫颈癌筛查（癌前病变及早期宫颈癌）诊断方面的相关文献,参照Cochrane系统评价的方法对资料进行统计分析。结果：共有12篇文献纳入研究,TCT合并的敏感性0．65（95％CI,0．62-0．68）,特异性0．93（95％CI,0．92-4）．93）,阳性预测值8．25（95％CI,5．65-12．04）,阴性预测值0．27（95％CI,0．18-0．41）,合并SROC曲线下面积AUC=0．889,Q值0．819。HPV合并敏感性0．69（95％CI,O．67~0．71）,特异性O．91（95％CI,0．90-0．91）,阳性预测值3．93（95％CI,2．99-5．18）,阴性预测值0．17（95％CI,0．09～0_31）,合并SROC曲线下面积AUC=0．871,Q值0．801。结论：薄层液基细胞学检查在宫颈癌筛查中具有较高的诊断准确度,与HPV联合检测可提高诊断的准确性。     

HPV-DNA 亚型检测联合液基细胞学对宫颈癌 筛查的临床价值

目的:探讨HPV-DNA亚型检测联合液基细胞学对宫颈癌筛查的临床价值.方法:对自愿接受宫颈癌筛查的女性1462例作为研究对象,分别对其进行HPV-DNA亚型检测以及液基细胞学的检查,对于出现阳性的患者进行病理组织学检查.结果:HPV+TCT对宫颈癌早期病变以及癌变的检出率为69.67％明显高于HPV检查的56.28％以及TCT检查的63.89％(P＜0.05);HPV+TCT对GIN Ⅰ、CIN Ⅱ、CINⅢ、癌的检出率分别为91.67％,92.86％、91.67％以及100％.结论:采用HPV-DNA亚型检测联合液基细胞学对宫颈癌筛查,可明显提高其对癌前病变的检出率,是一种高效、简单的检测方法.     

宫颈癌患者液基细胞学与组织学诊断的比较分析 仇

目的:通过对液基细胞学检测(TCT)与组织学活检的比较分析,探讨TCT出现漏诊的原因。方法:收集83例宫颈癌患者的宫颈活检组织蜡块和宫颈脱落细胞标本,组织蜡块行常规病理切片检查,脱落细胞标本进行TCT检测。结果:和组织病理学诊断结果比较,这些患者的TCT诊断漏诊18例。进行过抗HPV治疗的宫颈癌患者,其TCT漏诊率明显高于未治疗者(P<0.05)。结论:TCT在宫颈癌筛查中存在一定的漏诊,其产生的原因与癌细胞分化程度、宫颈糜烂程度、非诊断细胞的干扰、不当的采集方法及抗HPV治疗有关。     

液基细胞、HPV检测与阴道镜宫颈癌的筛查方面的应用研究

目的:探讨液基薄层细胞学检查、HPV-DNA检测、阴道镜检查在宫颈癌早期诊断中的临床应用价值.方法:回顾性分析92例宫颈液基薄层细胞学检查未能明确诊断意义的宫颈非典型鳞状细胞病变患者,进行HPV-DNA检测与阴道镜检查,将检测的结果进行对比研究.结果:阴道镜与宫颈液基薄层细胞检查(TCT)及HPV检测在宫颈上皮内瘤变的灵敏度相比,差异有统计学意义(P＜0.05),阴道镜的检出率最高.随着TCT结果的病变级别提高,HPV感染率也提高,ASCUS组与LSIL组之间差异有统计学意义(P＜0.05).ASCUS、LSIL、HSIL病理活检的阳性率差异明显(P＜0.05),有统计学意义.宫颈的不同病变年龄主要集中在31-50岁之间.结论:宫颈液基薄层细胞学检查异常的患者,应进行HPV检测及阴道镜下活检,三步筛查法可大幅度提高宫颈高度病变的检出率,并且30-50岁的女性应定期做宫颈细胞学检查、HPV检测及阴道镜检查.     

薄层液基细胞学检查在宫颈普查中应用的临床分析

目的：评价薄层液基细胞学检查在宫颈普查中应用的临床价值。方法：选择经薄层液基细胞学门诊普查妇女520例,其中经TCT检查结果提示ASCUS以上的妇女76例,均进一步采取阴道镜下宫颈活检病理检查,将TCT检查结果与阴道镜下宫颈活检病理检查结果对比分析。结果：TCT检查结果具有较高的检出率及符合率,HSIL组、SCC组与LSIL组符合率比较,差异具有统计学意义（P〈0.05）。结论：TCT检查作为妇科宫颈普查的方法,具有检出率及符合率高的优点;检查结果为HSIL或SCC时,应引起临床极高度重视。     

薄层液基细胞学检查在宫颈普查中应用的临床分析

目的:评价薄层液基细胞学检查在宫颈普查中应用的临床价值。方法:选择经薄层液基细胞学门诊普查妇女520例,其中经TCT检查结果提示ASCUS以上的妇女76例,均进一步采取阴道镜下宫颈活检病理检查,将TCT检查结果与阴道镜下宫颈活检病理检查结果对比分析。结果:TCT检查结果具有较高的检出率及符合率,HSIL组、SCC组与LSIL组符合率比较,差异具有统计学意义(P<0.05)。结论:TCT检查作为妇科宫颈普查的方法,具有检出率及符合率高的优点;检查结果为HSIL或SCC时,应引起临床极高度重视。     

宫颈特殊染色法、液基薄层细胞学及人乳头瘤病毒检测对宫颈癌前病变的应用价值分析

目的:探讨宫颈特殊染色法(FRD)、液基薄层细胞学(TCT)及人乳头瘤病毒(HPV)检测对宫颈癌前病变筛查的应用价值。方法:选取2015年1月～2018年1月于我院行宫颈癌筛查的1794例妇女作为研究对象,所有研究对象均接受FRD、TCT、HPV检测,以经阴道镜取样活检结果为阳性标准,对比分析三种不同检测方法以及联合检测的诊断效能。结果:病理科活检检出阳性111例,检出率为6.19%;FDR检测检出阳性114例,检出率为6.35%,漏诊率为16.22%;TCT检测检出阳性115例,检出率为6.41%,漏诊率为19.82%;HPV检测检出阳性108例,检出率为6.02%,漏诊率为19.82%;FRD检测与TCT、HPV检测的检出率比较差异无统计学意义(P0.05)。FRD检测敏感度为83.78%,特异度为98.75%,阳性预测值为81.58%,阴性预测值为98.93%;TCT检测敏感度为80.18%,特异度为98.46%,阳性预测值为77.39%,阴性预测值为98.69%;HPV检测敏感度为80.18%,特异度为98.87%,阳性预测值为82.41%,阴性预测值为98.70%;FRD、TCT、HPV联合检测敏感度为93.69%,特异度为99.52%,阳性预测值为92.86%,阴性预测值为99.58%;FRD、TCT、HPV联合检测与FRD、TCT、HPV单独检测的敏感度、阳性预测值比较差异具有统计学意义(P0.05)。结论:FRD、TCT、HPV检测对宫颈癌前病变的诊断效能相当,而FRD、TCT、HPV联合检测的诊断效能优于各方法单独检测。     

液基细胞学和DNA倍体检测筛查宫颈病变的临床研究

目的:研究液基细胞学和DNA倍体检测筛查宫颈病变的价值,为临床应用提供理论依据。方法:选择2011年6月-2013年5月在我院门诊就诊或体检中心体检,行宫颈癌筛查的2034名受试者,同时行宫颈液基细胞学检查和细胞DNA倍体分析,其中71人有组织病理学结果。结果:71例组织病理学结果中,组织学诊断慢性宫颈炎33例,CINⅠ21例,CINⅡ11例,CINⅢ6例;液基细胞学TBS分级26例WNL,24例ASCUS,4例ASC-H,14例LSIL,3例HSIL;DNA定量细胞学异倍体细胞数0个24例,1~2个35例,3~14个11例,15~个1例。ROC曲线液基细胞学曲线下面积为0.921(95%CI为0.859~0.983),DNA倍体检测曲线下面积为0.836(95%CI为0.743~0.929)。结论:液基细胞学与DNA倍体检测对筛查宫颈病变有较高的预测价值,值得在临床上推广应用。     

宫颈液基超薄细胞学检查临床应用价值探讨

目的探讨宫颈液基超薄细胞学检查（Thinp rep cytologic,TCT）和Bethesda系统（TBS）在宫颈病变诊断中的临床价值。方法对3146例本院宫颈疾病就诊者行TCT检查和TBS细胞学分类诊断,对TCT检查异常者进行阴道镜病理检查。结果异常涂片208例（占6．61％）,其中不典型鳞状细胞（ASC）68例（2．19％）,低度鳞状上皮内瘤变（LSIL）95例（3．02％）高度鳞状上皮内瘤变（HSIL）41例（1．31％）。鳞状细胞癌（SCC）4例（0．12％）。异常细胞涂片30-39岁80例（38．1％）,40—49岁55例（26．12％）,与其他年龄组比较差异有统计学意义（P〈0．05）。TCT检查与病理检查符合率分别为LSIL81％,HSIL92％,SCC100％,两者比较差异无统计学意义。结论TCT结合TBS应用于宫颈细胞涂片配合阴道镜活检,是筛查和诊断宫颈癌前病变的可靠手段。     

The potential of biobanked liquid based cytology samples for cervical cancer screening using Raman spectroscopy

Patient samples are unique and often irreplaceable. This allows biobanks to be a valuable source of material. The aim of this study was to assess the ability of Raman spectroscopy to screen for histologically confirmed cases of Cervical Intraepithelial neoplasia (CIN) using biobanked liquid based cytology (LBC) samples. Two temperatures for long term storage were assessed; 80°C and ?25°C. The utility of Raman spectroscopy for the detection of CIN was compared for fresh LBC samples and biobanked LBC samples. Two groups of samples were used for the study with one group associated with disease (CIN 3) and the other associated with no disease (cytology negative). The data indicates that samples stored at ?80°C are not suitable for assessment by Raman spectroscopy due to a lack of cellular material and the presence of cellular debris. However, the technology can be applied to fresh LBC samples and those stored at ?25°C and is, moreover, effective in the discrimination of negative samples from those where CIN 3 has been confirmed. Pooled fresh and biobanked samples are also amenable to the technology and achieve a similar sensitivity and specificity for CIN 3. This study demonstrates that cervical cytology samples stored within biobanks at temperatures that preclude cell lysis can act as a useful resource for Raman spectroscopy and will facilitate research and translational studies in this area.      

Estimating the sensitivity of cervical cytology: errors of interpretation and test limitations

The objective of this study was to estimate: (i) the sensitivity of cytologists in recognizing abnormal smears; (ii) the sensitivity of cervical cytology as a method of detecting abnormal smears among those obtained in the presence of cervical intraepithelial neoplasia (CIN). Study subjects were 61 women with a histologically confirmed CIN identified through colpohistological and cytologic screening. For objective (i) new smears were taken from study subjects just before treatment, mixed with routine preparations, interpreted by unaware cytologists and then blindly reviewed by a group of three expert supervisors, who reached a consensus diagnosis. Cytologists classified as positive for squamous intraepithelial lesion (SIL) 30 of the 34 smears judged as positive by supervisors (100% of smears classified as high-grade and 67% of smears classified as low-grade SIL by the supervisors). Our approach, based on creating a set of smears with a high a priori probability of being positive, proved to be an efficient way of estimating errors of interpretation. For objective (ii), smears taken at the moment of diagnosis, just before biopsy, were also reviewed by the same supervisors. These CIN cases were identified among asymptomatic women independently of cytological findings and results are therefore not subject to verification bias. Among the 33 histological CINII/III, four (12%) smears had no atypical cells (three negatives and one unsatisfactory) at review. The same proportion was 26% (four negatives and one unsatisfactory) among the 19 histological CINI. No significant differences in smear content were found between the seven ‘false negatives’ and a sample of ‘true positives’ and ‘true negatives’ for a number of formal adequacy criteria (including presence of endocervical cells). Strong differences were found between positive smears taken just before biopsy and those taken just before treatment (in 11 women the first smear only was positive, while the opposite was never observed), suggesting an effect of punch biopsy in removing lesions.     

European guidelines for quality assurance in cervical cancer screening: recommendations for cervical cytology terminology

There are many different systems of cytology classification used in the member states of the European Union (EU) and many different languages. The following short annexe to Chapter 3 of the European Guidelines for Quality Assurance in Cervical Cancer Screening provides a framework that will allow different terminologies and languages to be translated into standard terminology based on the Bethesda system (TBS) for cytology while retaining the cervical intraepithelial neoplasia (CIN) classification for histology. This approach has followed extensive consultation with representatives of many countries and professional groups as well as a discussion forum published in Cytopathology (2005;16:113). This article will describe the reporting of specimen adequacy, which is dealt with in more detail elsewhere in Chapter 3 of the guidelines, the optional general categorization recommended in TBS, the interpretation/cytology result and other comments that may be made on reports such as concurrent human papillomavirus testing and the use of automation review and recommendations for management. The main categories in TBS will be described in the context of CIN, dyskaryosis and dysplasia terminologies so that all may be translated into the same framework. These guidelines should allow European countries to adapt their terminology in such a way as to make their screening programmes comparable with each other as well as with programmes elsewhere in the world.     

European guidelines for quality assurance in cervical cancer screening: recommendations for cytology laboratories.

The quality of a cervical cytology laboratory depends on adequate handling and staining of the samples, screening and interpretation of the slides and reporting of the results. These guidelines give an overview of procedures recommended in Europe to manage the balance between best patient care possible, laboratory quality assurance and cost effectiveness and will be published as a chapter 4 in the European Guidelines for Quality Assurance in Cervical Cancer Screening. The laboratory guidelines include protocols for personnel and organisation, material requirements, handling and analysing cervical samples, recording of results, quality management and communication. The section on quality management is comprehensive and includes protocols for all aspects of internal and external quality assurance. The guidelines are extensively referenced and as far as possible the recommendations are evidence-based.     

Liquid-based cytology improves productivity in cervical cytology screening.

Objectives: The ThinPrep test was introduced into our institution on a phased basis over 3 years between January 2002 and December 2004. This study set out to assess its effect on productivity (as measured by output of cases per medical scientist per day) during the changeover period. Numbers of high and low-grade lesions and of unsatisfactory slides were also monitored. Methods: The percentage conversion from conventional preparation to liquid-based cytology (LBC) and output of cases per medical scientist per day were calculated from our database at 6-month intervals. The average backlog, average number of cases received per month and percentage of unsatisfactory and abnormal cases were calculated similarly. Results: Over the study period 92 084 cases were received. The percentage of cases using ThinPrep increased: from 9% in January 2002 to 73% in December 2004. During the study there was an increase in output from 17.0 to 22.3 cases per medical scientist per day, representing a 31% improvement at 73% conversion. Numbers of unsatisfactory cases decreased substantially and the numbers of low and high-grade diagnoses were relatively constant. Conclusions: The change to ThinPrep has improved productivity and decreased the number of unsatisfactory cases. There was no adverse effect on quality during the changeover.     

European guidelines for quality assurance in cervical cancer screening: recommendations for collecting samples for conventional and liquid-based cytology.

The current paper presents an annex in the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening. It provides guidance on how to make a satisfactory conventional Pap smear or a liquid-based cytology (LBC) sample. Practitioners taking samples for cytology should first explain to the woman the purpose, the procedure and how the result will be communicated. Three sampling methods are considered as acceptable for preparing conventional Pap smears: (i) the cervical broom; (ii) the combination of a spatula and an endocervical brush; and (iii) the extended tip spatula. Smear takers should take care to sample the entire circumference of the transformation zone, to quickly spread the cellular material over a glass slide, and to fix the preparation within a few seconds to avoid drying artefacts. According to local guidelines, one of these three methods may be preferred. Sampling with a cotton tip applicator is inappropriate. Similar procedures should be followed for sampling cells for LBC, but only plastic devices may be used. The collected cells should be quickly transferred into a vial with fixative liquid according to the instructions of the manufacturer of the LBC system. Subsequently, the slide or vial and the completed request form are sent to the laboratory for cytological interpretation.     

The role of cervical cytology and colposcopy in detecting cervical glandular neoplasia

Objective:  To determine the role of cervical cytology and colposcopy in the management of endocervical neoplasia.
Setting:  Colposcopy unit and cytology laboratory in a teaching hospital.
Sample:  Group 1 included 184 smears showing endocervical glandular neoplasia from 129 patients and group 2 included 101 patients with histology showing endocervical abnormalities in a 6-year period (1993–1998). Follow-up of 6–11 years to 2004 was available.
Methods:  Group 1 were identified from the cytology computer records. Group 2 were identified from histology records on the cytology database and a record of histology cases kept for audit purposes. The clinical records were examined retrospectively.
Results:  The positive predictive value (PPV) of abnormal endocervical cells in smears was 81.1% for significant glandular/squamous [cervical glandular intraepithelial neoplasia (CGIN)/cervical intraepithelial neoplasia grade2 (CIN2 or worse)] lesions. The PPV of colposcopy was 93.5% for significant glandular/squamous lesions of the cervix. The postcolposcopy probability of a significant lesion when colposcopy was normal was 87.5%. The sensitivity of colposcopy in detecting endocervical lesions was 9.8%. The sensitivity of cervical smears in detecting a significant endocervical abnormality (CGIN or worse) was 66.3%. The false negative rate for cytology of endocervical glandular lesions was 4.0%.
Conclusions:  Endocervical glandular neoplasia detected on cytology is predictive of significant cervical pathology even when colposcopy is normal, which supports excisional biopsy in the primary assessment of these smears. The high concomitant squamous abnormality rate justifies the use of colposcopy to direct biopsies from the ectocervix. Cervical cytology is the only current screening method for cervical glandular abnormalities but sensitivity is poor.     

The revised BSCC terminology for abnormal cervical cytology

The BSCC terminology was originally published in 1986 and although highly successful, requires revision. Through a process of professional consensus and literature review this has been undertaken by the BSCC. The revision takes account of recent developments and improvements in understanding of morphology and disease process and is compatible with other terminologies in use elsewhere, whilst still maintaining a focus on practice in the UK cervical screening programmes.