- 期刊
Discordance between Uterine Cervical Cytology and Biopsy: Results and Etiologies of a One - Year Audit
診斷不一致之陰道子宮頸抺片和活組織檢法：一年度之結果和原因探討
摘要
為探究診斷不一致之陰道子宮頸抹片和活組織檢法之原因，在研究的一年內，共篩檢了15474個陰道子宮頸抹片病例，其中427個病例為陽性結果，故此頁篩檢之陽性率為2.8％。這些陽性病例都有切片組織學的結果，其中有49個病例之細胞學與組織學的結果不一致，不一致率為11.5％。扣除10個抹片保存不良或無最後結果者，共有39個病例中，不一致的原因有30個病例（77％）為細胞學的錯誤造成，而有9個病例（23％）是由組織學的錯誤造成。故細胞學的錯誤是造成此不一致的主要原因。更進一步探討因：屬於細胞學判讀錯誤造成者有17個病例（44％），屬於細胞學採檢不良造成者有10個病例（25％），屬於組織學採檢不良造成者有6個病例（15％），屬於細胞篩檢錯誤造成者有3個病例（8％），屬於組織學判讀錯誤造成者有3個病例（8％）。故細胞學判讀錯誤是造成此不一致的主要因素。經此回溯性研究，我們通嘲得知細胞學與組織學診斷不一致的原因，如此可提高未來細胞學篩檢準確度，進而提升臨床上服務病人的品質。
關鍵字
無資料並列摘要
To investigate the etiologies of discrepancies between cervicovaginal smear and corresponding cervical biopsy results, a total of 15474 cervicovaginal smears were sampled in a one-year period. Among these, 427 patients were diagnosed with atypical squamous cells of undetermined significance (ASCUS), dysplasia, or malignancy. The screen positive rate was 2.8%. ALL of the positive cases had histologic follow-up. Forty-nine of the 427 patients had a discrepancy of at least two grades (the grades are divided to negative, ASCUS, mild dysplasia, moderate dysplasia, severe dysplasia and iveasive carcinoma), between the cytologic and histologic diagnoses. The discrepancy rate was 11.5%. Ten of these discrepant cases had poorly-preserved slides or a not definitely final diagnosis. A total of 39 cases (79.6%) of discrepancy were reviewed in this study. In thirty (77%) of the 39 discrepant cases, the errors were cytologic and in 9 cases (23%) the errors were histologic. Cytologic error was the major cause of cytohistologic discrepancy. The etiologies of cytohistologic discrepancy included: cytologic interpretation error, 17 cases (44%); cytologic sampling error, 10 cases (25%); biopsy sampling error, 6 cases (15%); cytologic screen error, 3 case (8%)l and biopsy interpretation error, 3 cases (8%), The major etiology of cytohistologic discordances was cytologic interpretation error. In this retrospective study, we determined the etiologies of cytohistologic discrepancies. This information can be useful for improving diagnostic accuracy and the quality of patient care.
延伸閱讀
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