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TCT in the screening of cervical lesions

Author: Anonymous From: www.yourpaper.net Posted: 2010-06-24 16:00:41 Read:
Author: Hu Jing Zi Lu Qin Yan Xu Hai seedlings
[Abstract] Objective To investigate the value of the thin layer of liquid-based cytology in the screening of cervical lesions. Methods A retrospective analysis of 3580 cases of ThinPrep liquid-based cytology March to July 2007 the Nanjing Military Region Hangzhou Sanatorium gynecological examination, and follow-up to get the results of the histological pathology epithelial cell abnormalities, then control the correlation analysis . Results epithelial cell abnormalities are 190 cases, accounting for 5.31%, including ASC-US 102 cases (2.85%), ASC-H (0.14%), LSIL 69 cases (1.93%), HSIL 14 cases (0.39%). 167 cases colposcopy histopathological results obtained by the follow-up, cytological and histological diagnosis was 76.1%, 32.9% with pathologically confirmed as CIN cytology ASC-US persons. Correlation analysis TCT results abnormal detection of CIN risk (RR) is much higher than the general population. The RR difference in comparisons between the two groups, the ASC-US group of LSIL detection of CIN II and CIN III / CIS RR value was not statistically significant (P = 0.26,0.76), ASC-US group detected in CIN I and HSIL group also not statistically significant (P = 0.91), and compare the differences between the other groups was statistically significant (P <0.05, data not shown). Conclusion TCT technology used in screening of cervical lesions, can effectively improve the detection rate of cervical lesions and cervical cancer, and the result is higher rate of histological and pathological control is an effective method of screening for cervical lesions. ASC-US cytological diagnosis must be given timely detection of high-risk HPV, colposcopy if necessary.
[Keywords] film thin layer of liquid-based cytology technique (TCT); screening for cervical intraepithelial neoplasia (CIN);
[Abstract] Objective To study the value of ThinPrep cytology test (TCT) in screening cervical intraepithelial lesion.Methods Examinination results of 3580 cases who were received TCT in health examination in Hangzhou sanatorium, Nanjing Military Command from March to July, 2007 were retrospectively analyzed.The cases with abnormal result were followed up and confirmed by histopathologic examination.Correlation analysis was conducted.Results The results of TCT demonstrated that there were 190 cases with abnormal epithelial cells among 3 580 cases (5.31%), including 102 cases of ASC-US (2.85%), 5 cases of ASC-H (0.14%), 69 cases of LSIL (1.93%) and 14 cases of HSIL (0.39%) .167 cases were received further pathological examination by colpomicroscope. The diagnose accordance rate of cytological and pathological examination was 76.1% .32.9% people with ASC-US were confirmed for CIN.The correlative analysis indicated that the risk ratio for detecting CIN in groups with abnormal epithelial cells confirmed by TCT was dramatically higher than that in common cases (P <0.05). There was no significant difference of the risk ratio for detecting CINII and CINIII / CIS between ASC-US and LSIL group (P = 0.26,0.76). The same as the risk ratio for detectingCINI between ASC -US and HSIL group (P = 0.91), whereas there was statistical significance between other groups (P <0.05). Conclusion Application of TCT in screening cervical intraepithelial lesion can effectively improve the detection ratio of cervical precancerosis as well as cervival cancer , and the diagnose accordance rate of TCT and pathological examination was relatively high, indicating TCT is an effective method for screening CIN.People with ASC-US should be focused and detected for high risk-HPV, and even received colposcopy examination if necessary.
[Key words] ThinPrep cytology test; Cervical intraepithelia neoplasm; Screening
Cervical intraepithelial neoplasia is one of the most common disorders of women, evolving eventually develop into cervical cancer. Cervical cytology cervical lesions and cervical cancer early detection and early treatment of the important means and preferred method. Now retrospective analysis of the results of our application ThinPrep membrane thin layer of liquid-based cytology (ThinPrep cytology test, TCT) 3580 healthy subjects screening of cervical lesions, abnormal epithelial cells and through follow-up which, cytology and histology results of comparative analysis to explore the value of the technology in the screening of cervical lesions.
1 Materials and Methods
1.1 General Information
Gynecological health examination in our hospital between March to July 2007, 3580 cases of TCT test results, and epithelial cell abnormalities were followed up to get the results of the histological pathology, age 25 to 73 years, average (42.11 0.62) years, with a median 43 years old.
1.2 liquid-based specimen collection and processing
Fully exposed cervical exfoliated cells of the cervix, mouth and cervical canal at the plastic brush sampler collection, the collected cells were washed into the ThinPrep preservation solution vial containing 2 cm in diameter made by the ThinPrep 2000 system program processing sheet, 95% ethanol, Pap staining, send Zhejiang Cancer Hospital cytopathology room by experts read the piece.
1.3 cytological diagnosis method
TBS (The Bethesda System) report of cervical lesions include benign cell changes and cervical intraepithelial neoplasia. Cervical intraepithelial neoplasia according to the degree can be divided into: atypical squamous cells, equivocal (atypical squamous cells of undetermined significance, ASC-US), atypical squamous cells, except for the high-grade squamous intraepithelial lesions ( atypical squamous cells, can not exclude high-grade squamous intraepithelial Lesion ASC-H), low-grade squamous intraepithelial lesions (low grade squamous intraepithelial Lesion LSIL), high-grade squamous intraepithelial lesions (high grade squamous intraepithelial Lesion, HSIL) , squamous cell carcinoma (squamous cell carcinoma, SCC), atypical glandular cells (atypical glandular of undermined the quad faces covering AGC) and adenocarcinoma. 1.4 Statistical analysis
Results using SPSS 11.5 statistical software the RR using Cochran's and Mantel-Haenszel statistical analysis, P <0.05 was considered statistically significant.
2 results
2.1 liquid-based cytology screening results
3580 cases of liquid-based cytology in cervical intraepithelial neoplasia 190 cases, accounting for 5.31%, the ASC-US102 cases (2.85%), ASC-H in 5 cases (0.14%), LSIL 69 cases (1.93%), HSIL (0.39%).
2.2 histology pathological findings
Follow-up on the the TCT results as ASC-US and above, the results (Table 1).
2.3 cytological results and histological correlation analysis of the pathological findings
Due to lack of repeatability and consistency of calculation specified in the cytological and histological diagnosis rate cytology diagnosis of ASC-US or more lesions, including ASC-US cytology diagnosis of ASC-US. Cytologic diagnosis of SIL (squamous intraepithelial lesion) 88 cases, histopathological diagnosis of CIN (cervical intraepithelial neoplasm) 67 cases, both diagnosis rate was 76.1%. Cytology and histology results of correlation analysis showed that TCT results abnormal detection of CIN risk (RR) is much higher than the general population (Table 2). Group comparisons, TCT prompted the group of ASC-US and LSIL group detection of CIN II and CIN III / CIS RR value was not statistically significant (P = 0.26,0.76), TCT prompted the ASC-US group and HSIL group seized CIN RR difference was not statistically significant, the comparison between the other groups the differences were statistically significant (P <0.05, data not shown).
discussion
Cervical precancerous lesions to develop into cervical cancer is a relatively slow process, which is about 5 to 10 years. Cervical cancer is preventable, treatable disease, screening to detect early cervical cancer, timely and appropriate treatment, the cure rate is close to 100%. In developed countries, the incidence decreased significantly, largely due to early diagnosis and treatment of cervical lesions.

Cervical cancer screening and producer of technical updates and breakthroughs in recent years, the cervical cancer prevention is early work to a new level. One of the new technologies TCT is currently in clinical applications more widely, than with the conventional Pap smear, it will not only greatly improve the specimens satisfaction, and made smear uniform thin sheet cell structure and a clear background, is conducive to the correct diagnosis. TCT results in this study 3580 patients with cervical intraepithelial neoplasia incidence of 5.31%, lower than the domestic literature reports [1-2], may be due to their observations outpatient rather than healthy volunteers, but higher than traditional Pap smear [3], and cytological and histological diagnosis of the overall compliance rate was 76.1%, showing that the TCT technology is able to improve the detection rate of abnormal cells, suitable for clinical screening of cervical lesions.

ASC-US cervical cytology TBS classification proposed diagnostic terminology [4], is a descriptive diagnosis, the diagnostic criteria for abnormal cells compared reactive changes more obvious but did not reach grade squamous intraepithelial lesions (SIL) the degree can a benign hyperplasia change or potentially malignant changes can not be clearly classified and named. The dyskeratosis cell atypical metaplasia, atypical repair cells atrophy the atypical squamous included in the ASC-US. ASC-US has been the difficulty of diagnosis and treatment of cervical lesions. Foreign literature diagnosis of ASC-US TCT examination accounted for about 5% [5], the majority of the literature from 5.71% to 7.23% [2], the diagnosis rate of 2.85% in this article with the Beijing Union Medical College Hospital reported similar (2.13%) [6]. Foreign literature on the ASC-US biopsy, of which 15% to 50% of CIN, 5% to 10% for moderate to severe CIN, some even to invasive cancer [7], the results are similar with. In this study, 79 cases of histologically control ASC-US results, 18 cases of CIN I, 5 cases of CIN II, 3 cases of CIN III / CIS, accounting for a total of 32.9%. Correlation analysis found that ASC-US and LSIL group detection of CIN II and CIN III / CIS RR value was not statistically significant (P = 0.26,0.76), so we should pay attention to a diagnosis of ASC-US patients, there are a number of studies show that high-risk HPV testing negative predictive value of 99% [8], can effectively triage patients, it is recommended for high-risk HPV testing should first ASC-US/LSIL HPV ( ) colposcopy, HPV (-) can continue screening program normal population.
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