妇科体检中应用TCT结合高危型HPV检测对宫颈上皮内瘤变的筛查价值

目的探讨妇科体检中应用液基细胞学（TCT）检查结合高危型HPV检测对子宫颈上皮内瘤病变的筛查价值。方法本院2010年1月～2011年12月6973例妇科体检宫颈液基薄层细胞学检查,采用美国新柏氏液基薄层细胞学（TCT）检测系统制片,细胞学诊断采用TBS分级系统。结果6973例液基薄层细胞学检查结果中,细胞学异常者为372例,阳性检出率为5．33％。372例细胞学检查阳性中,ASCUS286例（包含少量非典型鳞状上皮细胞）,占76．88％;LSIL28例,占i7．53％;ASCU—H27例,占7．26％;HSIL22例,占5．91％,非典型腺细胞（AGUS）6例,占1．61％,宫颈鳞癌（SCC）3例,占0．81％;对372例TCT阳性患者行HPV分型检测进行分流,286例ASCUS高危型或低危型HPV阳性者中154例进行阴道镜检查,对细胞学结果ASCUS以上的不论HPV检测是否阳性共计240例均进行阴道镜检查后行宫颈组织学活检,诊断CINI。Ⅲ患者126例,其中CINI36例,CINII36例,CINⅢ54例,宫颈鳞癌6例,慢性宫颈炎伴鳞化38例,HPV亚临床感染33例。宫颈上皮内瘤变的病理诊断符合率分别为ASCUS43．97％,LSIL96．55％,ASC—H100％,HSIL96．65％,SCC100％,AGUC：33．33％。结论液基薄层细胞学（TCT）检测系统是宫颈上皮内瘤变筛查的一种有效方法,宫颈或阴道炎症、HPV病毒感染都会引起宫颈细胞学的异常,有一定的局限性,对于细胞学检查异常的患者进行HPv病毒检测,即便细胞学异常级别较低,一旦合并高危型HPV病毒感染,也有宫颈上皮内瘤变的发生;TCT阳性、HPV阳性者再进行阴道镜检查取组织学,提高了诊断宫颈上皮内瘤变的符合率,对宫颈上皮内瘤变的及时干预和治疗,能有效预防宫颈癌的发生。     

宫颈液基细胞学联合阴道镜下活检对宫颈病变检查结果临床分析

目的评价宫颈新柏式膜式薄层液基细胞（TCT）配合阴道镜检查对子宫颈病变的诊断价值。方法2008年10月－2009年12月对我院妇科门诊1600例患者行TCT检查，异常者行阴道镜下多点活检及组织病理学检查，并进行临床与病理对照分析。结果TCT检查异常者196例（12．25％）。其中未明确诊断意义的不典型鳞状上皮细胞（ASCUS）98例（6．13％），低度鳞状上皮内病变（LSIL）58例（3．63％），高度鳞状上皮（HISL）内病变32例（2．00％），鳞癌（SCC）8例（0．50％）。196例均经阴道镜下多点活检病理组织学检查，诊断为炎症67例，占异常细胞学34．18％；宫颈上皮内瘤样病变（CIN）CINⅠ69例，占35．20％，CINⅡ21例占10．71％，CINⅢ16例，占8．16％，宫颈原位癌12例，占6．12％；宫颈浸润癌11例，占5．61％。结论宫颈薄层液基细胞学检查配合阴道镜下多点活组织病理检查，能及早发现宫颈癌前病变和宫颈癌。     

3种方法检测宫颈脱落细胞HPV感染结果的分析

目的 探讨3种方法检测宫颈脱落细胞人乳头瘤病毒(HPV)感染的内在联系及与薄层细胞学检测(TCT)结果的相关性.方法 用基因捕获DNA检测法(hC2)捕获样品HPV DNA解链、杂交,检测与宫颈癌高度相关的13种HPV.用实时荧光定量PCR(Q-PCR)法提取样品HPV DNA,扩增核酸在Q-PCR定量仪上检测结果.MPHC提取样品HPV DNA,扩增核酸,将扩增后的产物加到微孔板中进行杂交,加入酶标液,用酶标阅读仪测定结果.后两种方法检测病毒亚型数量与hC2法相同.本实验将hC2法与Q-PCR匹配检测260例宫颈脱落细胞HPV感染;将hC2法与MPHC匹配检测200例宫颈脱落细胞HPV感染情况.结果 3种方法在鳞状上皮异常改变组中,HPV检出阳性率均为100%;在鳞状上皮良性改变组中Q-PCR和MPHC检测HPV阳性结果绝大部分与hC2相符,只有较少部分样品结果在hC2阴性结果的范围内,灵敏度均＞hC2,MPHC假阳性率占2%.结论 HPV检测结果与TCT的结果相结合评价宫颈疾病、宫颈癌及癌前病变是最佳方案.     

不同筛查方法对宫颈高级别鳞状上皮内病变及以上的检出情况

目的 探讨宫颈液基细胞学、高危型人类乳头瘤病毒(HPV)及联合检测对宫颈高级别鳞状上皮内病变及以上的检出情况。方法 选择2019年6-9月首都医科大学附属北京妇产医院妇科门诊手术室行阴道镜检查的病例1721例，对其宫颈液基细胞学、HPV及宫颈活检病理结果进行回顾性分析及统计。结果 1721例中，年龄19～78岁，平均(41.04±10.84)岁。液基细胞学检测结果为不明意义的非典型鳞状细胞(ASC-US)、低级别鳞状上皮内病变(LSIL)、不能除外高度病变的非典型鳞状细胞(ASC-H)、高级别鳞状上皮内病变(HSIL)及非典型腺细胞(AGC)中病理检测为HSIL及以上的检出率分别为22.6%、25.0%、77.3%、90.9%和60.0%,均高于液基细胞学检测结果为无上皮内病变或恶性病变(NILM)的检出率(14.2%),差异均有统计学意义(P<0.05)。高危型HPV检测结果中，HPV16/18阳性和其他HR-HPV阳性中HSIL及以上检出率分别为22.8%和19.0%,均明显高于HPV阴性中的7.3%,差异均有统计学意义(P<0.05)。联合检测阳性656例中，HSIL...     

宫颈鳞状上皮内瘤变细胞学与组织学诊断的临床意义

目的探讨宫颈鳞状上皮内瘤变(CIN)的临床病理特征及早期诊断的临床意义。方法对512例妇女进行宫颈涂片细胞学检查,对可疑病例作宫颈组织活检进一步确诊。结果细胞学诊断有正常范围108例,炎症反应细胞303例,不典型鳞状细胞(ASCUS)39例,低度病变(LSIL)32例、高度病变(HSIL)30例,其中ASCUS、HSIL建议活检进一步确诊。组织学诊断69例患者中慢性宫颈炎伴轻~中度鳞状化生的5例,CIN1~3级的60例,宫颈原位癌2例,宫颈早期浸润癌2例。结论采用细胞学筛查、结合组织学诊断宫颈病变,对宫颈癌的早期发现、早期诊断,有非常重要的意义。     

高危型 HPV 及其分型检测在 ASCUS分流诊治中的价值研究

目的：探讨高危型人乳头瘤病毒（HPV）及其分型检测在意义不明的非典型鳞状上皮细胞（ASCUS）分流诊治中的临床应用价值。方法：选择宫颈液基细胞学（TCT）检查为ASCUS407例。采用基因芯片法进行高危型HPV及其分型检测，并行阴道镜检查。观察分析宫颈组织病理学与高危型HPV感染的关系，以及高危型HPV亚型与宫颈组织病理学的关系。结果：本组407例中，高危型HPV检测阳性（阳性组）211例，占51．8％；低危及阴性（阴性组）196例，占48．2％。高危型HPV阳性组中，宫颈上皮内瘤变（CIN）检出率为62．6％（132／211），非常显著高于阴性组的13．8％（27／196）（P〈0．01）；CINⅠ、CINⅡ、CINⅢ和浸润癌的检出率分别为79．6％、84．8％、94．1％和100．0％，均非常显著高于阴性组中的20．4％、15．2％、5．9％和0．0％（P〈0．01）。且高危型HPV感染率随着宫颈病变程度的加重而增高。高危型HPV阳性211例中，病理学诊断为CINⅡ及以上58例，以HPV16亚型最为常见，其次分别为HPV52、HPV18、HPV58和HPV33；HPV16、HPV52和HPV18亚型在CINⅡ及以上中占77．6％。结论：高危型HPV及其分型的检测，能够有效分流出ASCUS中高危人群，对ASCUS患者管理具有重要临床指导价值。     

阴道镜诊断子宫颈病变112例临床分析

目的 分析总结阴道镜诊断子宫颈病变的实用价值.方法 把做TCT及HPV宫颈癌筛查,查出为TCT异常或者TCT虽然正常但HPV16/18阳性的112例患者作为研究对象.都做了阴道镜检查及组织活检,对比分析阴道镜检查的实用价值.结果 112例研究对象中阴道镜诊断结果为宫颈癌2例,高级别病变(HSIL)23例,低级别病变(LSIL)52例,慢性宫颈炎伴柱状上皮外移31 例,湿疣改变 4例.112例研究对象病理结果证实宫颈癌 3例,高级别病变(HSIL)17例,低级别病变(LSIL)60例,慢性宫颈炎伴柱状上皮外移28 例,湿疣改变 4例.诊断符合率分别为67%,74%,87%,90%,100%.结论 阴道镜在诊断早期宫颈病变中很有实用价值.     

150例不同宫颈病变中HPV基因分型分析及意义

目的分析不同宫颈病变患者中HPV感染的基因分型。方法选择接受宫颈活检的妇女150例为研究对象,进行HPV-DNA检测,分析不同宫颈病变的HPV感染情况及HPV基因型亚型分布情况。结果宫颈鳞状细胞癌患者的HPV感染阳性率94．74％,CIN11IHPV感染阳性率71．43％,均远高于其他宫颈病变类型患者（P〈0．05）;高危基因型感染率为94．92％,其中前三位为HPV16、HPV51、HPV58,低危基因型包括HPV6、HPV11共3例（5．08％）。结论HPV感染率随着宫颈病变的严重程度上升而上升,通过对HPV进行亚型检测,有助于早期宫颈癌的预警及治疗,改善患者预后。     

宫颈液基细胞学联合阴道镜下活检对宫颈病变800例检查结果分析

目的：评价宫颈液基细胞学配合阴道镜检查对子宫颈病变的诊断价值。方法：2005年10月-2008年6月对我院妇科门诊800例患者行宫颈液基细胞学检查,异常者行阴道镜下多点活检。结果：宫颈液基细胞学检查异常者92例（11．5％）。其中未明确诊断意义的不典型鳞状上皮细胞（ASCUS）49例,低度鳞状上皮内病变（LSIL）31例,高度鳞状上皮内病变（HSIL）10例,鳞癌（SCC）2例。92例均经阴道镜下多点活检病理组织学检查,诊断为炎症61例,占异常细胞学66．30％;宫颈上皮内瘤样病变（CIN）CIN Ⅰ 13例（14．13％）,CINⅡ9例（9．78％）,CINⅢ4例（4．37％）,宫颈浸润癌5例（5．43％）。结论：宫颈液基细胞学检查配合阴道镜下多点活组织病理检查,能及早发现宫颈癌前病变和宫颈癌。     

某部军人宫颈人乳头状瘤病毒感染情况调查

目的：调查某部女性泌尿生殖道人乳头状瘤病毒（HPV）感染情况。方法：选择2008年9月--2012年7月在本院门诊就诊的体系部队女性泌尿生殖道炎1112例,提取宫颈脱落细胞通过核算扩增分型技术进行HPV检测。结果：HPV阳性140例,感染率为12．6％;易感年龄段为36~45岁。阳性标本以17种HPV亚型感染形式存在,其中阳性率最高为HPV16型,占36．2％。多重感染以HPV6、16、58和52型居多,其中二重感染4．1％,三重感染0．09％。结论：HPV在女性生殖道感染率较高,在初筛宫颈病变中应加强相关监测。     

Reliability of the CINtec p16INK4a immunocytochemical test in screening cervical precancerous lesions

BACKGROUND/AIM: Overexpression of p16INK4a has been found to be linked with genomic integration of high-risk human papillomavirus (HPV) and the developement of precancerous cervical intraepithelial lesions. The aim of this study was to examine is there a higher positive level of correlation between grade of histological dysplasia and p16INK4a level of expression in cervical smear, compared to results of Papanicolaou test. We also examined the correlation between HPV type, p16INK4a expression and Papanicolau test results. METHODS: A total of 48 women with precanceorous cervical lesions and HPV cervicitis and 10 healthy women were enrolled in the study. Papanicolaou test, CINtec p16INK4a cytological immunohistochemical test, polymerase chain reaction (PCR) HPV 16, 18, 31, 33 analysis and histopathology of the lesion were performed in all the patients. RESULTS: Comparing the results of Papanicoulaou test and the grade of histological dysplasia, low-grade squamous intraepithelial lesion (LSIL) was confirmed in 38%, and high-grade squamous intraepithelial lesion (HSIL) in 69.2% of the patients (p > 0.05). Significant positive correlation was found between p16 overexpression and grade of histological dysplasia (p = 0.000). Overexpression p16 was found in 70% of LSIL and 94.4% of HSIL. Positive correlation was found between p16 overexpression and grade of dysplasia in Papanicolaou test (p = 0.011). In 38% of LSIL and 15% of HSIL cases p16 was not expressed. The most frequently found HPV type in PCR analysis was HPV16. Analysing the results of p16 test according to HPV status and Papanicolaou test rather heterogenous results were obtained. CONCLUSION: In the patients with precancerous cervical lesions a higher level of correlation was found between the grade of histological dysplasia and p16INK4a level of expression in the cervical smear, compared to the results of Papanicolaou test.     

Therapeutic effects of topical photodynamic therapy with 5-aminolevulinic acid on cervical high-grade squamous intraepithelial lesions

BackgroundTopical photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) is a non-invasive option for treatment of Cervical Intraepithelial Neoplasia (CIN). We investigated the clinical efficacy and safety of ALA-PDT in treatment of patients with cervical high-grade squamous intraepithelial lesion (HSIL) and evaluated the factors that effect the efficacy of PDT.MethodsA total of 99 patients (average age: 30 years (18–45 years old)) with cervical HSIL and high-risk Human Papilloma Virus (hr-HPV) infections and who had received ALA-PDT were enrolled in this retrospective study. Before ALA-PDT, cervical exfoliated cells from all patients were obtained for HPV genotyping, liquid-based cytology test (LBC) and PAX1 methylation (PAX1^m) test. Then, 6 months after ALA-PDT, HPV genotyping, LBC and colposcopy-directed biopsy were conducted. During subsequent follow-up, HPV genotyping and LBC were performed, and colposcopy-directed biopsy was conducted if hr-HPV was positive and/or LBC result was abnormal.ResultsAt 6 months after treatment, total HPV clearance and lesions complete remission (CR) rates were 64.6% (64/99) and 88.9% (88/99), while at 1-year of follow-up, they were 81.3% (65/80) and 92.5% (74/80), respectively. At 1-year follow-up, HPV clearance rate was higher, relative to 6 months after ALA-PDT (p <0.05). At 6 months after treatment, HPV clearance and CR rates in the PAX1 hypermethylation (PAX1^hm) group were 36.8% and 73.7%, which were lower compared to the rates for PAX1 hypomethylation (PAX1^lm) group (71.3%, 92.5%) (p <0.05). Moreover, of the 11 patients with cervical canal lesions, 3 (3/7, 42.9%) patients had cervical canal HSIL persistence and the other 4 cervical canal HSIL and all of the 4 cervical canal LSIL had complete remission.ConclusionsALA-PDT is an effective, safe treatment approach for patients with cervical HSIL and hr-HPV infections. Patients with PAX1^lm showed better therapeutic outcomes than patients with PAX1^hm or cervical canal HSIL.     

Efficacy of photodynamic therapy with 5-aminolevulinic acid for the treatment of cervical high-grade squamous intraepithelial lesions with high-risk HPV infection: A retrospective study

BackgroundThe current principle of clinical management of cervical high-grade squamous intraepithelial lesion(HSIL) is surgical excision. However excisional procedures of the uterine cervix may have a negative impact on fertility. Topical photodynamic therapy(PDT) is a non-invasive and selective tissue destruction. We investigated the clinical efficacy of PDT for cervical HSIL with high-risk human papilloma virus(HPV) infection.MethodsA retrospective study consisting of 96 patients aged 20–50 years with a histologically confirmed cervical HSIL with high-risk HPV infection from July 2018 to June 2022 was carried out. Patients were treated with six times of 20% 5-aminolevulinic acid photodynamic therapy (5-ALA PDT) at intervals of 7–14 days. Three months after treatment, the effect was evaluated through HPV typing and colposcopy directed biopsy. Six and twelve months after treatment, TCT and HPV tests were carried out.ResultsThree months after 5-ALA PDT treatment, among 96 HSIL with high-risk HPV infection patients, the total lesion regression rate was 89.58%(86/96), and the HPV clearance rate was 79.17 % (76/96) at 3 months follow-up. At 6 and 12 months follow-up, the patients who was HSIL pathological regression and negative HPV at 3 months follow-up continued negative results in both TCT and HPV. All patients with ineffective 5-ALA PDT treatment had persistent HPV infections. There was no significant difference in the HSIL regression rate and HPV clearance rate among different age groups. The main side effects of PDT were abdominal pain and increased vaginal secretions. Univariate analysis showed that the different severity of cervical cytology was associated with lesion regression rate in 5-ALA PDT treatment. The HSIL regression rate of TCT<ASC-H was higher than that of TCT≧ASC-H(94.59% vs 72.72%; P<0.01).Multicentric lesions,the proportion of visible lesion size in ectocervical size≥24.59%, size of visible lesion ≥1.23cm² and maximum linear length of visible lesion ≥0.90cm were risk factors of HSIL persistence after 5-ALA PDT treatment (P<0.05).Conclusion5-ALA PDT can be a safe and efficient treatment for cervical HSIL who wish to preserve fertility. 5-ALA PDT did not appear to create cervical damage and have negligible side effects. But we need evaluate the type of transformation zone, the visible lesion size, the location of lesion,baseline status of TCT and histological results before 5-ALA PDT treatment.     

Evaluation of 5-aminolevulinic acid-mediated photodynamic therapy on cervical low-grade squamous intraepithelial lesions with high-risk HPV infection

BackgroundThe treatment options for low‐grade squamous intraepithelial neoplasia (LSIL) of the cervix with high-risk HPV infection have not been standardized. Studies show that photodynamic therapy (PDT) mediated by 5-aminolevulinic acid (ALA-PDT) might be effective. In this retrospective study, the clinical efficacy and safety of ALA-PDT in the treatment of LSIL were evaluated.MethodsALA-PDT was performed in 55 LSIL patients aged 21–45 years who also showed high-risk HPV infection and cervical ectropion. HPV test, cytology, colposcopy and pathology were examined before and after treatment. Meanwhile, PDT-related symptoms and adverse reactions were also reviewed.ResultsAt 6-month follow-up after PDT, except for 5 patients who showed the persistence of LSIL lesions, the pathological regression ratio of 90.1% (50/55) was achieved. No HPV-DNA was detected in exfoliated cervical cells in 81.8% (45/55) patients. Among them, the HPV clearance ratio of I Degree cervical ectropion was 96.2%, significantly higher than that of II Degree (70.8%) and III Degree (60%). Significant shrunk of cervical ectropion and reduction of vaginal secretions after PDT were seen in 78.0% patients.ConclusionALA-PDT is a safe and effective therapeutic option for patients of reproductive age who suffer from LSIL with high-risk HPV infection and cervical ectropion.     

人乳头瘤病毒检测在宫颈疾病诊断中的意义

目的探讨人乳头瘤病毒(HPV)检测在宫颈疾病诊断中的应用及临床意义。方法选取2009年5月—2010年11月520例在大连医科大学附属一院三部妇科就诊妇女为研究对象,取宫颈脱落细胞采用导流杂交基因芯片(HybriMax)法行HPV检测,同时结合组织病理学检查进行分析,明确HPV感染与宫颈疾病的关系及宫颈癌的发生、发展过程。结果 HPV总感染率为48.8%,30～39岁年龄组HPV感染率最高为54.5%;组织病理学诊断慢性宫颈炎症、低级别病变(CINⅠ)、高级别病变(CINⅡ～Ⅲ)、宫颈原位癌或浸润癌中高危HPV感染检出率以42.2%、65.8%、95.4%、100.0%依次递增。结论宫颈疾病与高危型HPV感染有着十分密切的关系,引起宫颈肿瘤的最主要原因是高危型HPV感染,高危型HPV检测可作为宫颈癌的一种重要筛查手段。     

基因芯片检测宫颈癌石蜡标本HPV感染的临床意义

目的探讨用基因芯片检测宫颈癌石蜡标本中人乳头瘤病毒(HPV)感染的可行性和临床意义。方法收集2005年5月-2007年2月在解放军总医院住院的宫颈癌患者的石蜡组织标本48例,其中鳞癌37例,腺癌11例。从组织中提取DNA后,应用基因芯片检测23种HPV亚型,即PCR扩增后产物在基因芯片上进行杂交。结果基因芯片检测出44例宫颈癌有高危型HPV感染,感染率为91.7%(44/48),其中宫颈鳞癌的感染率为94.6%(35/37),宫颈腺癌的感染率为81.8%(9/11)。单一感染33例,占75.0%(33/44);混合感染11例,其中双重感染9例,多重感染2例,分别占20.5%(9/44)和4.6%(2/44)。基因芯片检测出的主要致病亚型为HPV16,占90.9%(40/44);HPV18为第二致病亚型,占27.3%(12/44);HPV52、33、59、68等致病亚型较少见。35例宫颈鳞癌HPV感染患者中,HPV16亚型感染率为91.4%(32/35),HPV18亚型感染率为22.9%(8/35);9例宫颈腺癌中,HPV16亚型感染率为88.9%(8/9),HPV18亚型占44.4%(4/9)。结论基因芯片可检测出多种HPV亚型,特异性强,敏感性高,对宫颈癌致病机制的研究及其预防具有重要意义。     

HR-HPV检测在宫颈细胞学异常患者中的意义

目的：探讨高危型人乳头状瘤病毒（ high-risk human papillomavirus, HR-HPV）检测在宫颈细胞学异常患者中的应用价值。方法选择2011-01至2012-04宫颈细胞学诊断异常患者872例,采用杂交捕获二代（ hybridization captureⅡ,HC-Ⅱ）进行高危型HPV检测;按宫颈组织病理学结果分为NILM组（ negative for intraepithelial lesion or malignancy, NILM）、宫颈上皮内瘤变（cervical intraepithelial neoplasia, CIN）Ⅰ、Ⅱ、Ⅲ、宫颈鳞癌组（invasive cervical cancer, ICC）。用Spearman等级相关分析HPV病毒载量与宫颈病变级别的关系。结果872例细胞学异常患者中ASC-US、ASC-H、LSIL、HSIL组HR-HPV阳性率分别为31．6％、59．7％、50．3％、89．6％;NILM组、CINI、CINⅡ、CINⅢ、ICC组HR-HPV阳性率分别为25．2％、53．4％、86．7％、96．4％、100％,差异有统计学意义（P＜0．01）;HC-Ⅱ法诊断宫颈高度病变（≥CINⅡ）的灵敏性、特异性、阳性预告值、阴性预告值分别为93．1％、66．8％、59．9％、94．8％;不同病理级别组HPV病毒载量差异有统计学意义（P＜0．05）,NILM组HPV病毒载量低于CIN各组以及宫颈癌组（P＜0．05）,CIN以及宫颈癌组HPV病毒载量差异无统计学意义。结论随着组织病理学级别的升高,HR-HPV阳性率呈上升的趋势;HR-HPV病毒载量与CIN及宫颈癌发生有关,但与宫颈病变的严重程度无关。