Beerman H, van Dorst E B L, Kuenen-Boumeester V, Hogendoorn P C W
Department of Pathology, Maasstad Hospital, Rotterdam, The Netherlands.
Gynecol Oncol. 2009 Mar;112(3):572-6. doi: 10.1016/j.ygyno.2008.12.012. Epub 2009 Jan 16.
Liquid-based cytology may offer improvements over conventional cytology for cervical cancer screening. The two cytology techniques were compared in a group of 86,469 women who participated in a population-based screening program. Using a nation-wide pathology database containing both cervical cytology and histology records for all patients, we compared the outcome of the two screenings methods with regard to the detection rate of histological proven abnormalities and the determination of the true false-negative rates for both methods.
Two cohorts of women living in the same geographical region were used. Cohort 1 (n=51,154 women) was analysed using conventional cytology (conventional cohort) and cohort 2 (liquid cohort) (n=35,315 women) was analysed using liquid-based cytology (SurePath). The samples were processed in one laboratory. The results of histological follow up were available via a central database.
The rate of unsatisfactory slides was significantly lower using liquid-based cytology (0.13% vs. 0.89%, p<0.0001). Detection of ASCUS+ (Atypical squamous cells of unknown significance or higher abnormalities) was significantly higher using liquid-based cytology (2.97% vs. 1.64%, p<0.0001), mainly due to the increase in the ASCUS category. The percentage of histological abnormalities within the ASCUS samples was approximately equal in both cohorts, indicating that more true abnormal cases were detected using liquid-based cytology. The sensitivity for detection of a histological proven lesion is significantly higher in the liquid cohort compared to the conventional cohort (96.2% vs. 92.0%), with only a slight difference in specificity (97.8% vs. 98.2%).
This population study confirmed previous institution-based reports of decreased numbers of unsatisfactory samples based on liquid-based cytology and showed an increased sensitivity for the detection of cytological abnormalities that was validated by subsequent histological investigation.
在宫颈癌筛查中，液基细胞学检查可能比传统细胞学检查更具优势。在一组86469名参与基于人群的筛查项目的女性中，对这两种细胞学技术进行了比较。利用一个包含所有患者宫颈细胞学和组织学记录的全国性病理数据库，我们比较了两种筛查方法在组织学证实的异常检出率以及两种方法的真假阴性率测定方面的结果。
使用了居住在同一地理区域的两组女性。队列1（n = 51154名女性）采用传统细胞学检查（传统队列）进行分析，队列2（液基队列）（n = 35315名女性）采用液基细胞学检查（SurePath）进行分析。样本在一个实验室进行处理。组织学随访结果可通过中央数据库获得。
液基细胞学检查不满意涂片的比例显著更低（0.13%对0.89%，p < 0.0001）。液基细胞学检查对意义不明确的非典型鳞状细胞（ASCUS）及以上异常（ASCUS+）的检出率显著更高（2.97%对1.64%，p < 0.0001），主要是由于ASCUS类别中的增加。两个队列中ASCUS样本内组织学异常的百分比大致相等，这表明使用液基细胞学检查能检测到更多真正的异常病例。与传统队列相比，液基队列中组织学证实病变的检测敏感性显著更高（96.2%对92.0%），特异性仅有轻微差异（97.8%对98.2%）。
这项人群研究证实了先前基于机构的报告，即基于液基细胞学检查的不满意样本数量减少，并显示出对细胞学异常检测的敏感性增加，这一点在随后的组织学调查中得到了验证。
