摘要
目的比较高危型人乳头瘤病毒(HR-HPV)检测与薄层液基细胞学(TCT)检查在宫颈癌筛查中的准确性,探讨不同筛查方法的临床应用。方法选取2016年10月—2017年3月于我院就诊的女性病人,采用TCT联合HR-HPV检测进行宫颈癌筛查,将结果为意义不明的不典型鳞状细胞(ASCUS)及以上级别或者HRHPV检测阳性的病人作为研究对象。所有研究对象均在阴道镜下行多点活检,并将病理检查结果与HR-HPV检测结果和TCT结果进行比较分析。结果本研究共纳入病例660例。在387例TCT结果为ASCUS的病人中,病理结果示高度鳞状上皮内瘤变(HSIL)者64例、浸润癌2例,两者共占17.05%;108例TCT结果为低度鳞状上皮内瘤变(LSIL)的病人中,病理结果显示为HSIL者43例,符合率为67.59%;51例TCT结果为HSIL的病人中,病理结果显示为HSIL者45例、浸润癌2例,符合率为94.12%;在TCT阴性的114例病人中,病理结果显示为HSIL者19例、浸润癌1例,两者共占17.54%。在432例HR-HPV阳性病人中,病理结果示HSIL及浸润癌者共168例,占38.89%;228例HR-HPV阴性病人中,病理结果示HSIL者8例、宫颈癌1例,两者占3.95%。25~34岁年龄组TCT符合率显著高于HR-HPV符合率(χ2=8.643,P<0.01)。结论 TCT在筛查高级别宫颈病变方面的准确性较高,但也存在较高的漏诊率。对于35岁以上的女性,建议将HR-HPV检测作为宫颈癌筛查的初筛手段,并结合TCT检查,以最大限度地减少漏诊病例。
Objective To investigate the accuracy of high-risk human papillomavirus （HR-HPV） test versus thin-layer cytology test （TCT） in cervical cancer screening and the clinical effect of different screening methods. Methods TCT combined with HR-HPV test was used for cervical cancer screening in female patients who visited our hospital from October 2016 to March 2017, and those with atypical squamous cells of undetermined significance （ASCUS） or higher grade results or those with positive HR-HPV were enrolled in this study. Multi-point biopsy was performed for all patients under a colposcope, and pathological results were compared with the results of HR-HPV test and TCT. Results A total of 660 patients were enrolled in this study. Among 387 patients with ASCUS determined by TCT, 64 had high squamous intraepithelial lesion （HSIL） and 2 had invasive carcinoma according to the pathological results, who accounted for 17.05%. Among 108 patients with low squamous intraepithelial lesion （LSIL） determined by TCT, 43 had HSIL according to the pathological results, resulting in a coincidence rate of 67.59%. Among 51 patients with HSIL determined by TCT, 45 had HSIL and 2 had invasive carcinoma according to the pathological results, resul- ting in a coincidence rate of 94.12%. Among 114 patients with negative results of TCT, 19 had HSIL and 1 had invasive carcinoma according to the pathological results, who accounted for 17.54%. Among 432 patients with positive HR-HPV, a total of 168 pa- tients had HSIL and invasive carcinoma according to the pathological results, accounting for 38.89%. Among 228 patients with negative HR-HPV, 8 had HSIL and 1 had cervical carcinoma according to the pathological results, accounting for 3.95%. In the 25--34 years group, the coincidence rate between TCT and pathological results was significantly higher than that between HR- HPV and pathological results （X2 38.643, P〈0.01）. Conclusion Although TCT has high accuracy in screening out HSIL pa- tients, it has a high rate of missed diagnosis. As for women aged above 35 years, HR-HPV test is recommended to be used in pri- mary screening for cervical cancer and can be applied in combination with TCT to minimize the number of cases of missed diagnosis.
作者
任士霞
李连芹
REN Shixia, LI Lianqin(Department of Obstetrics and Gynecology, Binzhou Medical University, Yantai 264003, Chin)
出处
《精准医学杂志》
2017年第6期669-672,共4页
Journal of Precision Medicine
基金
山东省自然科学基金项目(ZR2015HL090)
关键词
宫颈肿瘤
人乳头瘤病毒
细胞学技术
诊断
uterine cervical neoplasms
human papillomavirus
cytological techniques
diagnosis
