Nishio Hiroshi, Iwata Takashi, Nomura Hidetaka, Morisada Tohru, Takeshima Nobuhiro, Takano Hirokuni, Sasaki Hiroshi, Nakatani Eiji, Teramukai Satoshi, Aoki Daisuke
Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
Jpn J Clin Oncol. 2018 Jun 1;48(6):522-528. doi: 10.1093/jjco/hyy050.
Liquid-based cytology (LBC) and conventional cytology (CS) are routine diagnostic techniques in cervical cytology, but few studies have compared their diagnostic performances with each other and with histologic diagnosis. This study aimed to compare the diagnostic performances of these techniques in subjects with abnormal cervical cytology of atypical cells of undetermined significance (ASC-US) or worse.
A total of 312 patients diagnosed with ASC-US or worse were enrolled in this prospective study in Japan from 2013 to 2014. LBC and CS samples were prepared by a split-sampling technique and evaluated blindly. The results were classified using the Bethesda System 2001. Colposcopy and biopsy were conducted simultaneously or within 4 weeks of cytology-specimen collection in all cases. Diagnostic performance was calculated in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detection of CIN2 or worse, with a cut-off ASC-US or worse.
There was one unsatisfactory CS sample and the remaining 311 cases were evaluated. The sensitivities of LBC and CS were 100.0% and 98.8%, specificities were 17.2% and 23.8%, PPVs were 56.1% and 57.9% and NPVs were 100.0% and 94.7%, respectively. LBC had slightly higher sensitivity and NPV for detection of CIN2, but there was no significant difference between the two methods.
There was no significant difference in the diagnostic performances of LBC and CS in patients with ASC-US or worse. LBC may therefore be an alternative approach to CS for cervical cancer screening.
液基细胞学检查（LBC）和传统细胞学检查（CS）是宫颈细胞学的常规诊断技术，但很少有研究将它们彼此之间以及与组织学诊断的诊断性能进行比较。本研究旨在比较这些技术在宫颈细胞学异常为意义不明确的非典型细胞（ASC-US）或更严重情况的受试者中的诊断性能。
2013年至2014年在日本，共有312例被诊断为ASC-US或更严重情况的患者纳入了这项前瞻性研究。通过分流采样技术制备LBC和CS样本，并进行盲法评估。结果根据2001年贝塞斯达系统进行分类。所有病例均在细胞学样本采集的同时或4周内进行阴道镜检查和活检。以ASC-US或更严重情况为临界值，计算检测CIN2或更严重病变的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）来评估诊断性能。
有1份CS样本不满意，其余311例进行了评估。LBC和CS的敏感性分别为100.0%和98.8%，特异性分别为17.2%和23.8%，PPV分别为56.1%和57.9%，NPV分别为100.0%和94.7%。LBC在检测CIN2方面的敏感性和NPV略高，但两种方法之间无显著差异。
在ASC-US或更严重情况的患者中，LBC和CS的诊断性能无显著差异。因此，LBC可能是CS用于宫颈癌筛查的替代方法。
