未明确诊断意义的不典型鳞状上皮细胞临床处理方法的探讨

摘要

Objective Not explicitly discuss the diagnosis of atypical squamous cells of clinical treatment, to provide reference for clinical treatment Test program. Methods The hospital in February 2009~2014 February clinic liquid-based cervical cytology is not explicitly confirmed the diagnosis of atypical squamous cells of 345 patients as observed objects were randomly divided into A, B, c three groups: group A 124 patients after three months again, liquid-based cervical cytology; 113 patients in group B after liquid-based cervical cytology finished joint inspection of high-risk human papil omavirus; 108 patients in Group C joint colposcopy and cervical biopsy after liquid-based cytology is completed. Inspection of the three groups of patients with atypical squamous epithelial cells of cervical intraepithelial neoplasia.Results Group A cytological abnormality detection rate of 54.05%of CIN, cytology normal CIN detection rate 6.89%, the dif erence was statistical y significant (χ²=8.81,P<0.05);B HPV-positive detection rate in CIN to 43.90%, HPV-negative not check out CIN; 108 patients in Group C direct colposcopy and biopsy detection rate of 29.63% CIN;invasive cervical cancer was not found; Group A method for predicting cervical high-grade lesions in ASCUS (CIN≥aboveII) sensitivity of 73.9% and a specificity of 72.8% and a negative predictive value of 97.7%, a positive predictive value of 26.4%, the proportion of Group B were 100.0%, 65.8%, 100.0%, 26.7%, by ROC analysis of the two methods to predict the inflection point was no significant dif erence (P>0.05) in patients with cervical ASCUS accuracy of high-level lesions. Conclusion High-risk groups or people in need of poor compliance or colposcopic biopsy to detect high-risk HPV, and make personalized management of patients with ASCUS.%目的：探讨未明确诊断意义的不典型鳞状上皮细胞的临床处理方法,为临床处理提供参考方案。方法将我院2009年2月~2014年2月门诊进行宫颈液基细胞学检查确诊为未明确诊断意义的不典型鳞状上皮细胞的345例患者作为观察对象,将其随机分为甲、乙、丙三组：甲组124例患者3个月后再次进行宫颈液基细胞学检查；乙组113例患者在宫颈液基细胞学检查完毕后联合高危型人乳头瘤病毒检查；丙组108例患者在宫颈液基细胞学检查完毕后联合阴道镜检查并活检。比较三组不典型鳞状上皮细胞患者宫颈上皮内瘤变的检查情况。结果甲组细胞学异常的CIN检出率为54.05%,细胞学正常的CIN检出率为6.89%,差异有统计学意义(χ²=8.81,P<0.05)；乙组HPV阳性中CIN检出率为43.90%,HPV阴性中未检查出CIN；丙组108例患者直接进行阴道镜活检CIN的检出率为29.63%；未发现宫颈浸润癌；甲组方法预测ASCUS中宫颈高级别病变(CIN≥Ⅱ以上)的灵敏度为73.9%,特异性为72.8%,阴性预测值为97.7%,阳性预测值为26.4%,乙组这一比例分别为100.0%、65.8%、100.0%、26.7%,经ROC分析,在拐点处两种方法预测ASCUS患者中宫颈高级别病变的准确性无统计学差异(P>0.05)。结论对高危人群或依从性差人群需进行高危HPV检测或阴道镜活检,并做好ASCUS患者的个性化管理。