Zhu Jie, Norman Ingrid, Elfgren Kristina, Gaberi Vera, Hagmar Bjorn, Hjerpe Anders, Andersson Sonia
Department for Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska University Hospital at Huddinge, Karolinska Institute, S-141 86 Stockholm, Sweden.
Oncol Rep. 2007 Jul;18(1):157-60.
The implementation of population-based screening for cervical cancer with Pap smear in the early sixties was set to detect and treat precancerous lesions, hopefully preventing a subsequent invasive cervical cancer. Epidemiological data indicate that organized screening has a major impact on morbidity and mortality from cervical cancer. The limited sensitivity of a single smear necessitates repeated smears in organized program. It is suggested that liquid-based cytology improves the sensitivity. The aim of this split-sample study was to compare ThinPrep liquid-based cytology with conventional Pap smear, relying on a laboratory with long-term experience of the latter. In total, 137 women with atypical Pap smear in population-based cervical screening were enrolled for the split-sample study. The performance of both techniques (ThinPrep liquid-based cytology and conventional Pap smear) were compared and validated by a histological follow-up. Women without representative histological biopsy were excluded from the study. Pap smear had sensitivity for detection of CIN2-3 of 47% compared to 66% for liquid-based material. The concordance of the two sampling techniques with the histological diagnosis was 37% and 53%, respectively, this difference being statistically significant. The proportion of reports on atypical squamous cells of undetermined significance (ASCUS) was significantly less in the liquid-based material, 4.3% compared to 8% of the conventional smears. This improved sensitivity in combination with the possibility to perform reflex testing such as HPV DNA or p16 immunocytochemistry without renewed sampling gives ThinPrep a substantial advantage and makes the liquid-based technique interesting.
20世纪60年代初实施的基于人群的子宫颈癌巴氏涂片筛查旨在检测和治疗癌前病变，有望预防随后的浸润性宫颈癌。流行病学数据表明，有组织的筛查对宫颈癌的发病率和死亡率有重大影响。单次涂片的敏感性有限，因此在有组织的筛查项目中需要重复涂片。有人认为液基细胞学可提高敏感性。这项分样本研究的目的是将ThinPrep液基细胞学与传统巴氏涂片进行比较，依托一家对后者有长期经验的实验室。总共有137名在基于人群的子宫颈癌筛查中巴氏涂片结果异常的女性被纳入分样本研究。通过组织学随访对两种技术（ThinPrep液基细胞学和传统巴氏涂片）的性能进行了比较和验证。没有代表性组织学活检的女性被排除在研究之外。巴氏涂片检测CIN2-3的敏感性为47%，而液基材料为66%。两种采样技术与组织学诊断的一致性分别为37%和53%，这种差异具有统计学意义。液基材料中意义不明确的非典型鳞状细胞（ASCUS）报告比例显著较低，为4.3%，而传统涂片为8%。这种提高的敏感性，再加上无需重新采样即可进行HPV DNA检测或p16免疫细胞化学等反射性检测的可能性，使ThinPrep具有显著优势，并使液基技术颇具吸引力。
