巴氏涂片联合液基细胞学筛查宫颈癌癌前病变的价值

目的:探讨巴氏涂片法联合液基细胞学（liquid-based cytology test，LCT）筛查宫颈癌癌前病变的应用价值。方法:选取1 000例2014年3月至2017年4月进入我院进行宫颈癌癌前病变筛查的患者作为研究对象，对其进行巴氏涂片法、液基细胞学及两者联合检测，比较三种方式的灵敏度、特异度、准确度、约登指数。结果:单用巴氏涂片法检测的灵敏度、特异度、准确度、约登指数分别为45.90%、96.06%、93.00%、0.42，单用LCT检测分别为77.05%、90.31%、89.50%、0.67，LCT联合巴氏涂片法检测分别为78.69%、97.87%、96.70%、0.76。单独使用LCT检测的灵敏度较单独使用巴氏涂片高（P＜0.05），而两种方法的特异度、准确度比较无显著差异（P＞0.05）。LCT联合巴氏涂片法检测的灵敏度较单独使用巴氏涂片法有明显提高（P＜0.05），准确度较单独使用LCT检测法有显著提高，特异度无显著差异（P＞0.05）。单用LCT检测判断正确的比例比单用巴氏涂片法判断正确的比例高（NRI值=0.24）；LCT联合巴氏涂片法检测判断正确的比例比单用巴氏涂片法和单用LCT法判断正确的比例均高，其中NRI值分别为0.34和0.32。结论:巴氏涂片法联合液基细胞学能准确地检测出宫颈癌病变，数据较准确可靠，有较高的临床应用价值。

Value of Pap smear combined with liquid-based cytology in screening precancerous lesions of cervical cancer

Objective:To evaluate the value of Pap smear combined with liquid-based cytology test (LCT) in the screening of precancerous lesions of cervical cancer.Methods:A total of 1 000 patients were enrolled in this study from March 2014 to April 2017 for cervical cancer precancerous lesions.The patients were treated with Pap smear，liquid-based cytology and combined detection.Three ways of sensitivity，specificity，accuracy，Jorden index were compared.Results:The sensitivity，specificity，accuracy and Jorden index of Pap smear test were 45.90%，96.06%，93.00% and 0.42 respectively.These of LCT test were 77.05%，90.31%，89.50% and 0.67 respectively.These of LCT combined with Pap smear test were 78.69%，97.87%，96.70% and 0.76 respectively.The sensitivity of LCT alone was higher than that of Pap smear alone (P<0.05),while the specificity and accuracy of the two methods were not significantly different (P>0.05).The sensitivity of LCT combined with Pap smear method was higher than Pap smear method alone (P<0.05),and the accuracy was higher than LCT assay.But the specifity didn' t have significant difference (P>0.05).The correct proportion of single LCT detection was higher than that of single Pap smear(NRI=0.24).LCT combined with Pap smear method was used to determine the correct proportion,which was higher than that of single Pap smears and single LCT method (NRI=0.34,0.32 respectively).Conclusion:Pap smear method combined with liquid-based cytology can accurately detect cervical cancer lesions.The data is more accurate and reliable，which has a high clinical value.