Gupta S, Halder K, Khan V A, Sodhani P
Division of Cytopathology, Institute of Cytology and Preventive Oncology (ICMR), Noida, Uttar Pradesh, India.
Cytopathology. 2007 Oct;18(5):309-15. doi: 10.1111/j.1365-2303.2007.00477.x. Epub 2007 Aug 6.
To assess the utility of indigenously prepared cell blocks (CBs) as an adjunct to a conventional smear test in providing a reliable diagnosis of clinically suspicious cervical cancer in resource-limited settings.
Eighty-six clinically suspicious cervical cancer cases underwent a conventional smear test, CB preparation from residual cellular samples and biopsies at the same sitting. Correlations were performed between these modalities in order to derive the sensitivity and specificity of the CB technique to diagnose cervical cancer.
OBSERVATION & RESULTS: Out of 86 clinically suspicious cervical cancers, 72 (83.7%), 70 (81.4%) and 67 (77.9%) cases were diagnosed as malignant on tissue biopsies, CBs and smears respectively. CB-biopsy agreement in the diagnosis of malignancy was feasible in 87.5% of the cases while CB-Pap smear agreement was feasible in 92.5% of the cases. Sensitivity and specificity of CB preparation to diagnose malignancy was 92.5% and 100%, respectively, when the smear was taken as the reference test (excluding the unsatisfactory smears). When biopsy was taken as the gold standard, the sensitivity and specificity of CBs were 87.5% and 100% respectively (excluding the unsatisfactory biopsies). In 8/19 cases where the smear diagnoses were either unsatisfactory or atypical squamous cells/atypical glandular cells, CBs picked up malignant lesions.
CBs prepared from the residual cellular sample of conventional cervical scrapes augment the sensitivity of the smear test. When used as an adjunct to the smear, CBs aid in providing a reliable diagnosis of cervical cancer in the majority of the clinically suspected cases and thus the biopsy load can be reduced significantly in resource-poor settings.
评估在资源有限的环境中，本地制备的细胞块（CBs）作为传统涂片检查的辅助手段，用于可靠诊断临床可疑宫颈癌的效用。
86例临床可疑宫颈癌病例在同一次就诊时接受了传统涂片检查、从残留细胞样本制备CBs以及活检。对这些检查方式进行相关性分析，以得出CB技术诊断宫颈癌的敏感性和特异性。
在86例临床可疑宫颈癌病例中，分别有72例（83.7%）、70例（81.4%）和67例（77.9%）在组织活检、CBs和涂片检查中被诊断为恶性。CB与活检在恶性诊断方面的一致性在87.5%的病例中可行，而CB与巴氏涂片的一致性在92.5%的病例中可行。以涂片检查为参考试验（不包括不满意的涂片）时，CB制备诊断恶性肿瘤的敏感性和特异性分别为92.5%和100%。以活检为金标准时，CBs的敏感性和特异性分别为87.5%和100%（不包括不满意的活检）。在19例涂片诊断为不满意或非典型鳞状细胞/非典型腺细胞的病例中，有8例CBs检测到恶性病变。
从传统宫颈刮片的残留细胞样本制备的CBs提高了涂片检查的敏感性。当作为涂片检查的辅助手段时，CBs有助于在大多数临床疑似病例中提供可靠的宫颈癌诊断，从而在资源匮乏的环境中可显著减少活检量。
