[摘要] 目的:探讨液基细胞学检查用于外来工妇女宫颈癌前病变筛查中的诊断价值及宫颈癌筛查现状。方法:应用液基细胞学(TCT)对到我院门诊就诊的外来工妇女(外来组)2 500名和进行常规宫颈癌前病变筛查的常住妇女1 600名(本地组)进行对比,并对其中细胞学筛查异常者进行阴道镜及镜下宫颈活检病理检查。结果:外来工妇女中,检测前有阴道排液或性生活出血等症状者878例,占35.12%,本地组有症状者87例,占5.43%。外来组共检测出细胞阳性368例,占14.72%,本地组异常例数为110例,占6.87%,两组比较,差异有统计学意义(P<0.05)。对细胞学检查异常者进行阴道镜及镜下宫颈活检病理检查,其中CINⅠ级以上360例,符合率达75.3%。结论:门诊就诊的外来妇女与本地妇女相比较,宫颈癌前病变发病率较高,有症状者来院就诊比率明显升高,外来组妇女对宫颈癌前病变筛查认识普及率低下,因此常规对外来工就诊妇女进行液基细胞学检查,并结合阴道镜宫颈活检,是筛查和诊断宫颈癌前病变的可靠手段。
[关键词] 液基细胞学;宫颈癌前病变;外来工
[中图分类号] R737.33[文献标识码] B [文章编号] 1673-7210(2011)07(a)-084-02
The clinical significance of screening tests for precancerous lesions of the uterine cervix by means of liquid based cytology in female migrant workers
LU Xiaoyan, XIE Jiabin, YANG Buqin
Department of Obstetrics, Songgang People"s Hospital of Shenzhen City, Guangdong Province, Shenzhen518105, China
[Abstract] Objective: To discuss the diagnostic value of screening tests for precancerous lesions of the uterine cervix by means of liquid based cytology in female migrant workers and to survey the status of screening tests for precancerous lesions of the uterine cervix. Methods: 2 500 female migrant workers who went to our hospital for treatment in the method of liquid based cytology (TCT) compared with 1 600 towns women who went to our hospital for routine examination in screening tests for precancerous lesions of the uterine cervix, then examined the women whose index were abnormal by means of colposcopy and cervical biopsy. Results: 878 female migrant workers had the symptoms of draining the liquid from vagina before examination and bleeding during intercourse, accounting for 35.12%; and 87 towns women had the symptoms, accounting for 5.43%. There were 368 cases in female migrant workers whose index were positive, accounting for 14.72%; and 110 cases in towns women whose index were abnormal, accounting for 6.87%. The differences between the two groups had statistical significance (P<0.05). there were 360 cases whose index were higher than CINⅠ after examined the women whose index were abnormal by the means of colposcopy and cervical biopsy, the concordance rate was 75.3%. Conclusion: The incidence of precancerous lesions of the uterine cervix in migrant group is higher than that in native group, and the rate of seeing doctor timely increased significantly, a small proportion of female migrant workers realize the importance of screening tests for precancerous lesions of the uterine cervix. So it is a reliable method for screening and diagnosing in precancerous lesions of the uterine cervix in the means of liquid based cytology combined with colposcopy and cervical biopsy.
[Key words] Liquid based cytology; Precancerous lesions of the uterine cervix; Migrant workers
宫颈癌是妇科常见恶性肿瘤,是导致发展中国家妇女死于癌症的重要因素。进行宫颈癌筛查,早期发现癌前病变是防治宫颈癌的关键。而目前液基细胞学(TCT)为妇女宫颈癌前病变进行筛查的对象主要为城镇居民,对于外来女工的筛查却鲜有报道。目前我国年轻宫颈癌患者呈明显增多趋势,外来女工大部分处于年轻阶段,TCT联合阴道镜活检及病理诊断对该类群体尤为重要。该研究回顾性分析了TCT对2 500名外来女工和1 600名本地妇女进行宫颈癌前病变筛查结果,报道如下:
1资料与方法
1.1 一般资料
以2009年5月~2010年4月来我院就诊并进行TCT检测的2 500名外来女工作为外来组,年龄18~55岁,平均(30.5±5.2)岁;选择同期常规进行TCT检测的1 600名本地妇女作为本地组,年龄20~55岁,平均(31.3±4.8)岁,所有妇女均为已婚或有性生活非孕期妇女,两组年龄差异无统计学意义(P>0.05)。
1.2 宫颈细胞取材办法
先用无菌干棉球轻轻擦去宫颈表面黏液,采用宫颈细胞刷插入宫颈口内1 cm,保持适当压力,顺时针旋转5~10圈,在宫颈外口及宫颈管处收集脱落细胞,取出细胞刷放入液基细胞保存液中,充分漂洗10次左右,保存液送病理科TCT制片,有专业人员阅片。
1.3 细胞学诊断方法
采用TBS分类标准:①未见上皮内病变或癌变(NILM);②不明确意义的不典型鳞状上皮细胞(ASC-US);③不除外上皮内高度病变的不典型鳞状细胞(ASC-H);④低度鳞状上皮内病变(LSIL);⑤高度鳞状上皮内病变(HSIL);⑥鳞状细胞癌(SCC);⑦意义不明的不典型腺上皮细胞(AGUS)和不典型腺上皮细胞倾向瘤变(AGC-fn);⑧腺原位癌(AIS);⑨腺癌(AC)。除正常范围外,其余诊断均为细胞学阳性[1]。
1.4 统计学处理
采用SPSS 13.0统计软件对实验数据进行统计分析,两组间的计数资料比较采用χ2检验,P<0.05为差异有统计学意义。
2 结果
2.1 TCT检查情况
外来组就诊时有阴道排液增多或性交出血症状者878例(35.12%),本地组有症状者87例(5.43%),由此可见外来组妇女有症状后始来院就诊比例明显升高,而本地组定期检查TCT,能做到早发现、早诊断、早治疗,比例明显降低,两组差异有高度统计学意义(P<0.01)。外来组中有84.6%(2 115/2 500)从未行TCT检测,本地组中仅有0.19%(3/1 600),两组差异有高度统计学意义(P<0.01),外来组能定期检测的占10.40%(260/2 500),而本地组占98.87%(1 582/1 600),两组间对比见表1。
2.2 TCT异常检出率
外来组细胞学异常检出率14.72%(368/2 500),本地组检出率6.87%(110/1 600),两组差异有高度统计学意义(P<0.01)。两组间对比见表2。
2.3 组织病理学检查结果
外来组与本地组细胞学检查阳性共478例,均行阴道镜检查宫颈活检,病理报告为宫颈上皮内瘤变360例,其中,CINⅠ268例,CINⅡ58例,CINⅢ31例,鳞癌3例。阴道镜检查宫颈活检与病理诊断符合率为75.31%,宫颈癌符合率达100%。
3讨论
宫颈癌是妇女最常见恶性肿瘤之一,居第2位,仅次于乳腺癌,在发达国家,宫颈癌发生率明显下降,很大程度上是因为其重视宫颈癌前病变的早期诊断和治疗。大量研究提示,CIN发展为浸润癌需10~15年,而原位癌发展为浸润癌约需3~4年,如能及时发现和治疗CIN,可阻遏宫颈浸润癌的发生[2]。因此,要预防宫颈癌发生,就要从CIN的筛查工作做起。近年来,TCT已成为宫颈癌筛查的首选方法。
本研究应用TCT对2 500名门诊就诊的外来女工与本地常住妇女进行宫颈癌前病变的筛查,发现外来组细胞学异常发生率为14.72%,本地组为6.87%,外来组异常检出率明显高于本地组,对于细胞学异常的病例进行阴道镜活检病理学检查,符合率达75.31%。表明TCT应用于宫颈病变筛查,能明显提高宫颈异常细胞的检出率,减少假阳性率[3-6]。本研究中外来女工均来自农村,流动性大,受经济条件和生活卫生状况的限制,大多数人对发病情况、病因及宫颈癌筛查认识非常缺乏,在2 500名就诊的妇女中,有2 155名从未行TCT检测,所占比例高达84.60%,极少数主动要求行TCT检查。出现症状后就诊者所占比例为35.12%,远高于常住人群。其余首次筛查者是到院就诊时,经医生宣教筛查必要性后才接受检查,因此该组妇女宫颈细胞异常检出率明显升高。外来女工防癌意识淡漠,对相关知识严重缺乏,宫颈癌筛查覆盖率过低,应该受到全社会的关注。我们可通过本院附属各社康中心定期发放宫颈癌筛查的相关宣传手册,到外来工聚集区域宣传TCT检查的重要性,把该人群作为宫颈癌筛查的重点人群。TCT检查作为宫颈癌筛查的一种常规手段,可以做到早诊断、早发现、早治疗[7],很大程度上可改善外来女工的健康状况,减轻其经济负担,发挥较好的社会效益,具有重要临床价值。
[参考文献]
[1] 苗凤英,胡玉莲,栾珍,等.阴道镜及液基细胞筛查宫颈病变临床研究[J].中国妇幼保健,2007,22(15):83-84.
[2] 徐又先,陈广莉,李立,等.液基细胞学联合荧光检测HPV在宫颈病变筛查中的作用[J].中国妇幼保健,2010,25(7):988-989.
[3] 顾美皎.TBS系统中异常上皮细胞的诊断和处理[J].中国应用妇科与产科杂志,2003,19(8):454-455.
[4] 刘阳,郝惟聪.液基细胞学联合阴道镜检查在诊断宫颈病变中的应用[J].中国医药导报,2007,4(2):127.
[5] 何维艳.液基细胞学技术筛查宫颈病变850例分析[J].临床医药实践,2010,19(1):15-16.
[6] 王智园,张维彬,石灵春.宫颈液基细胞学与组织学诊断结果对照及误差分析[J].广州中医药大学学报,2008,25(5):465-467.
[7] 邓运书.宫颈液基细胞学筛查564例的结果分析[J].中国医学创新,2009,6(35):32-33.
(收稿日期:2011-04-18)