Curiel-Valdés J J, Briones-Pimentel J, Bandala C
Laboratorio de Patología Grupo Diagnóstico México D.F. México ; Academia Mexicana de Cirugía, ASCP México.
Laboratorio de Patología Grupo Diagnóstico México D.F. México.
Int J Clin Exp Pathol. 2014 Aug 15;7(9):5895-901. eCollection 2014.
Sensitivity of cervical cytology is suboptimal, especially in developing countries such as Mexico, despite available guidelines aimed at improving this. When obtaining cervical samples, whether the samples are taken from the transformation zone and whether abnormal cells are missing must be considered. Cervical secretions (CS) are always present in variable proportions, and when cleaning the cervix, better samples may be obtained. In this study, we analyzed samples obtained with or without cleaning the cervix, and compared their contents in order to determine the sensitivity and specificity of these two methods.
Of 500 patients who underwent cytology and colposcopy, 271 (54.2%) required a second opinion due to a diagnosis of cervical intraepithelial neoplasia (CIN). CS was removed and compared with the clean, second sample (SS) using in both liquid-based cytology. The quality of samples according to the Bethesda System, the presence of CIN, and inflammatory reactions were recorded. The sensitivity and specificity were calculated using biopsy as the gold standard.
The SS resulted in a higher proportion of adequate samples being obtained (97.6% vs. 44.8%), and in increased sensitivity (88.2% vs. 58.8%). CIN was detected in the SS 26% more often than in the CS (34 vs. 27 samples), whereas inflammatory reactions were noted more often in the CS (91.4% vs. 74%).
Cervical sampling including CS results in lower sensitivity and CIN detection rates, and in more inflammatory reactions. By excluding CS from cervical samples, the sensitivity could be improved and the false negative rate could be reduced.
尽管有旨在改善宫颈细胞学检查的可用指南，但宫颈细胞学检查的敏感性仍不理想，尤其是在墨西哥等发展中国家。在获取宫颈样本时，必须考虑样本是否取自转化区以及是否遗漏异常细胞。宫颈分泌物（CS）总是以不同比例存在，在清洁宫颈时，可能会获得更好的样本。在本研究中，我们分析了清洁宫颈和未清洁宫颈时获取的样本，并比较了它们的内容，以确定这两种方法的敏感性和特异性。
在500例接受细胞学检查和阴道镜检查的患者中，271例（54.2%）因诊断为宫颈上皮内瘤变（CIN）而需要二次诊断。去除CS，并将其与两种情况下液基细胞学检查中清洁后的第二个样本（SS）进行比较。记录根据贝塞斯达系统分类的样本质量、CIN的存在情况以及炎症反应。以活检作为金标准计算敏感性和特异性。
SS获得的足够样本比例更高（97.6%对44.8%），敏感性也更高（88.2%对58.8%）。在SS中检测到CIN的频率比CS高26%（34例对27例），而CS中炎症反应更常见（91.4%对74%）。
包括CS的宫颈采样导致敏感性和CIN检测率较低，炎症反应更多。通过从宫颈样本中排除CS，可以提高敏感性并降低假阴性率。
