三阶梯筛查与人乳头瘤病毒检测在宫颈癌筛查中的应用价值研究

摘要

目的：探讨液基薄层细胞学(TCT)检查及高危型人乳头瘤病毒(HPV)检测在宫颈癌初筛中的不同临床应用价值。方法对1092例25~57岁的妇女进行免费 TCT 及高危型 HPV 检测, TCT 检查诊断为不明确的非典型鳞状细胞(ASCUS)及以上者或高危型 HPV 检测为阳性者均进行阴道镜下活检并送病理。结果TCT 检查1092例受检者中, TCT 阳性236例,检出率21.61%,其中包括 ASCUS 126例、鳞状上皮低度病变(ISIL)34例、鳞状上皮高度病变(HSIL)74例、鳞状细胞癌(SCC)2例。ASCUS 中活检为宫颈上皮内瘤样病变(CIN)者58例,病理组织学符合率为46.03%；LSIL 中活检为 CIN 者24例,病理组织学符合率为70.59%；HSIL 中活检为 CIN 者66例,病理组织学符合率为89.19%；SCC 中活检为SCC 者2例,病理组织学符合率为100.00%。TCT 阳性者与病理组织学总符合率达63.56%。1092例受检者中, HPV 阳性者512例, 检出率为46.89%。其中病理活检为炎症者332例, 占 64.84%,病理活检为CIN Ⅰ级及以上者180例,占35.16%(其中 CIN Ⅰ级128例、CIN Ⅱ级30例、CIN Ⅲ级20例、SCC 2例)。与 TCT 检查的组织符合率(63.56%)相比,差异有统计学意义(χ2=52.86, P<0.05)。结论与 HPV 病毒检测相比, TCT 检测的组织学诊断符合率更高,特别是对于 TCT 检测结果为 HSIL 者；对于 TCT 检测结果为 ASCUS 者, HPV 病毒检测可以起到有效的分流管理作用。%Objective To investigate different clinical application value of thinprep cytology test (TCT) and high risk human papilloma virus (HPV) detection in screening of cervical intraepithelial neoplasia. Methods TCT and high risk HPV detection were given to 1092 women aging 25~57 years old. Colposcopic biopsy and pathological detection were made for patients with atypical squamous cells of undetermined significance (ASCUS) in TCT and positive high risk HPV detection. Results Among 1092 patients in TCT, there were 236 positive TCT cases, with the detection rate as 21.61%. There were 126 ASCUS cases, 34 low-grade squamous intraepithelial lesion (LSIL) cases, 74 high-grade squamous intraepithelial lesion (HSIL) cases, and 2 squamous cell carcinoma cases. Biopsy showed 58 cervical intraepithelial neoplasia (CIN) cases in ASCUS, with histopathologic coincidence rate as 46.03%; 24 CIN cases in LSIL, with histopathologic coincidence rate as 70.59%; 66 CIN cases in HSIL, with histopathologic coincidence rate as 89.19%; 2 CIN cases in SCC, with histopathologic coincidence rate as 100%. Total histopathologic coincidence rate in positive TCT patients was 63.56%. There were 512 positive HPV cases among 1092 patients, with detection rate as 46.89%. Biopsy showed 332 inflammation cases, accounting for 64.84%, 180 CIN Ⅰ and higher level cases, accounting for 35.16% (128 CIN Ⅰ cases, 30 CIN Ⅱ cases, 20 CIN Ⅲ cases, and 2 SCC cases). The difference of coincidence rate in TCT (63.56%) had statistical significance (χ2=52.86, P<0.05). Conclusion Comparing with HPV detection, TCT provides higher histopathologic coincidence rate, especially for those with HSIL in TCT. HPV detection can provide scattered management effect for ASCUS cases in TCT.