摘要目的 探讨影响宫颈液基细胞学高度鳞状上皮内病变(HSIL)诊断准确性的原因.方法 收集2007至2010年间415例细胞学诊断为HSIL的病例,将细胞学结果与组织学结果对照分析,复查液基细胞学制片及组织学切片,分析误诊原因.结果 共42209例受检者进行了ThinPrep液基细胞学检查,其中细胞学诊断为HSIL者415例,占筛查人群的1.0％.HSIL患者的平均年龄41.6岁,30～ 49岁为高发年龄.325例细胞学诊断为HSIL的病例其组织学诊断结果为:阴性/炎性改变23例(7.1％),宫颈上皮内病变(CIN)1级/人乳头状瘤病毒(HPV)感染22例(6.8％),CIN2级/CIN3级223例(68.6％),鳞状细胞癌(SCC)57例(17.5％).细胞学HSIL对组织学CIN2级及以上病变的阳性预测值为86.2％ (280/325),对组织学CIN1级以上病变的阳性预测值为92.9％(302/325).细胞学假阳性的原因主要是组织学取材阴性、细胞学片中出现反应性腺上皮、孤岛状萎缩及放化疗反应等.细胞学诊断为HSIL而组织学诊断为SCC者57例(17.5％),误诊的原因主要为社会因素、对部分低分化SCC的细胞学表现认识不足,以及细胞学片中缺乏典型癌性特征.结论 细胞学HSIL对宫颈CIN2级/CIN3级及SCC的阳性预测值较高,但存在与组织学诊断结果不符的情况,细胞学医师和妇科医师应注意避免造成不一致的因素.

abstractsObjective To investigate factors affccting the diagnostic accuracy of cervical liquidbased cytology for high-grade squamous intraepithelial lesion (HSIL).Methods A retrospective evaluation of cytological and histological slides was performed in 415 patients who had cytological HSIL between 2007and 2010.Results Among 42 209 cases screened by ThinPrep liquid-based cytology,415 cases ( 1.0％ )of HSIL were eventually identified.The mean age of HSIL patients was 41.6 years,and 30 -49 years were the most common age group.Among 415 cases,325 patients had available histological diagnosis as follows:23 (7.1％) negative,22 (6.8％ ) CIN1/HPV,223 (68.6％) CIN2/CIN3,and 57 ( 17.5％ ) squamous cell carcinoma (SCC). The positivc predictive values of HSIL to predict CIN2 (or higher grade of dysplasia) and CIN1 were 86.2％ (280/325) and 92.9％ (302/325),respectively.Inadequate biopsy,reactive glandular cells,islet atrophy,chemo/radiotherapy and others were responsible for the cytologically false-positive diagnosis. Fifty-seven ( 17.5％ ) cases of HSIL had a histological diagnosis of SCC. The possible causes of misdiagnosis were social factors, under-recognized cytological features of poorlydifferentiated SCC and absence of typical diagnostic features in cytology slides.Conclusions Cytology of HSIL has a high positive predictive value for the presence of CIN2/CIN3 and SCC. Cytologists and gynecologists should be aware of the diagnostic pitfalls that may lead to the discrepancy between cytology and histology.