高危型人乳头瘤病毒检测联合薄层液基细胞学检查在宫颈疾病筛查中的应用

摘要

目的：进行高危型人乳头瘤病毒(HR-HPV)检测,分析液基薄层细胞学(TCT)检测与组织病理学诊断结果的符合情况,探讨二者联合检测对宫颈癌及癌前病变的筛查价值和意义。方法对1374例妇瘤科就诊患者,进行 HR-HPV、TCT 联合检测,对结果进行对比分析。结果684例意义不明的不典型鳞状细胞(ASCUS)患者病理学诊断结果中,炎症占51.3%,不典型增生轻度(CINⅠ)占47.4%；375例低度鳞状上皮内病变(LSIL)患者病理学诊断结果中,CINⅠ占48.5%,CINⅡ~Ⅲ占21.3%；294例高度鳞状上皮内病变(HSIL)患者病理学诊断结果中,CINⅠ占24.5%,CINⅡ~Ⅲ占62.9%；20例 SCC 患者病理学诊断结果中,CINⅡ~Ⅲ占20%,宫颈癌占80%。统计学分析显示,TCT 诊断与组织病理学诊断构成比差异有统计学意义(P <0.05)。HR-HPV 阳性率为74.3%,阴性率为25.7%。HR-HPV 阳性率随病理级别的升高而显著升高。HR-HPV 阳性组与阴性组病理诊断级别构成比差异有统计学意义(P <0.05)。TCT 与高危型 HPV 联合检测时,其灵敏度为76.5%,特异度为80.3%,联合检测的灵敏度和 TCT 差异有统计学意义(P <0.05),联合检测的特异度和 HR-HPV 差异有统计学意义(P <0.05)。结论 HR-HPV 检测与 TCT 联合能够提高宫颈病变的检出率,是一种较为理想的宫颈癌筛查方法。%Objective To study the status of coincidence of high-risk human papillomavirus(HR-HPV)test and thinprep cytolo-gy test with biopsy histopathologic diagnosis.And to investigate the value of combined detection in the diagnosis of the cervical cancer and precancerous lesions.Methods High-risk HPV test and thinprep cytology test were taken simultaneously in 1374 pa-tients visiting department of gynecological oncology.The diagnostic value of combination assay of these indices was evaluated.Re-sults In 684 patients with ASCUS pathology diagnosis,inflammation accounted for 5 1.3% and CINⅠ accounted for 47.4%.A-mong the 375 patients with LSIL pathology diagnosis,CINⅠ accounted for 48.5% and CIN Ⅱ-Ⅲ accounted for 21.3%.Among the 294 patients with HSIL pathological diagnosis,CIN accounted for 24.5%,and CIN Ⅱ-Ⅲ accounted for 62.9%.Among 20 pa-tients with SCC pathology diagnosis,CIN Ⅱ - Ⅲ accounted for 20% and cervical cancer accounted for 80%.Statistical analysis showed the difference of diagnostic results between thinprep cytology test and histopathologic diagnosis was statistically significant (P <0.05).The positive rate of high-risk HPV was 74.3%,and the negative rate was 25.7%.The positive rate of high-risk HPV significantly increased along with the rise of pathological level.The difference of pathologic diagnosis results between high-risk HPV positive group and negative group was statistically significant (P <0.05).When thinprep cytology test combined with high-risk HPV test,its sensitivity was 76.5%,and the specificity was 80.3%.The difference of the sensitivity between joint detection and thinprep cytology test was statistically significant (P <0.05).The difference of the specificity between joint detection and high-risk HPV test was statistically significant (P <0.05).Conclusion Combined thinprep cytology test and high-risk HPV test will improve the detection rate of cervical lesions and it is an ideal method to screen for cervical cancer.