阴道镜下活检、TCT及HPV检测对宫颈病变的诊断价值

目的 探讨利用阴道镜下活检来进行液基细胞学检查(TCT)和人乳头瘤病毒(HPV)检测对宫颈病变的诊断价值.方法 2015年1月至2016年6月期间在凉山州德昌县人民医院妇科门诊进行宫颈癌初次筛查的1300例患者作为研究对象,进行阴道镜下活组织检查、TCT、以及高危型HPV-DNA检测.确诊标准是阴道镜下活检法,并以此评价TCT、HPV及二者联合检测对于宫颈癌早期病变的诊断价值.结果 ①TCT检测,阳性患者有234例(18.00%),正常者及良性宫颈炎症有1066例(82.00%);234例阳性患者中,非典型鳞状上皮细胞病变患者112例(8.62%),低度鳞状上皮内病变患者65例(5.00%),高度鳞状上皮内病变患者43例(3.31%),鳞状细胞癌患者14例(1.08%);②通过HPV-DNA检测,阳性患者有679例(52.23%);③TCT和HPV-DNA联合检测的灵敏度为100.00%,即所有患者的指标均至少有一种呈现为阳性,而TCT单独检测的灵敏度为77.12%,假阴性(漏诊率)为22.88%,HPV单独检测的灵敏度为84.50%,假阴性(漏诊率)为15.50%.HPV联合TCT检测的检出率均显著高于TCT、HPV单一检测的检出率(χ2值分别为27.469、17.477,均P<0.01),HPV单一检测的检出率显著高于TCT单一检测的检出率(χ2=4.759,P<0.05).结论 采用阴道镜下活检、TCT及HPV对宫颈癌早期病变进行检测,具有高效性、可行性,HPV联合TCT检测能提高宫颈癌检测灵敏度,降低假阴性率,对宫颈癌的早期筛查具有重要价值.

Diagnostic value of TCT and HPV detection by colposcopic biopsy on cervical lesions

Objective To investigate the diagnostic value of TCT and HPV detection by colposcopic biopsy on cervical lesions .Methods Altogether 1300 outpatients receiving primary screening of cervical cancer were selected as research objects .All cases were detected by colposcopic biopsy , liquid-based thinlayer cytologic test ( TCT) and high risk human papilloma virus ( HPV) DNA test, and colposcopic biopsy result was used as diagnosis criteria .Based on it , diagnostic value of TCT , HPV and their combination detection on early stage of cervical cancer was assessed .Results TCT test showed 234 positive cases (18.00%) and 1066 normal and benign inflammation cases (82.00%).Among 234 positive cases, there were 112 cases (8.62%) of atypical squamous cell lesion , 65 cases (5.00%) of low-grade squamous intraepithelial lesion , 43 cases (3.31%) of high-grade squamous intraepithelial lesion and 14 cases (1.08%) of squamous cell carcinoma.HPV-DNA test showed 679 positive cases (52.23%).The sensitivity of TCT combined with HPV-DNA test was 100.00%. All patients had at least one positive indicator .Sensitivity of single TCT detection was 77.12%, with false negative rate (missed diagnosis rate) of 22.88%.Sensitivity of single HPV detection was 84.50%with false negative rate ( missed diagnosis rate ) of 15.50%.Detection rate of TCT combined with HPV-DNA test was remarkably higher than that of single TCT or HPV test (χ2 value was 27.469 and 17.477, respectively, both P<0.01), and that of single HPV test was higher than that of single TCT test (χ2 =4.759, P<0.05).Conclusion Clinical use of colposcopic biopsy , HPV and TCT for early cervical lesion screening has high efficiency and feasibility .Combined detection of HPV and TCT can improve sensitivity and reduce false negative rate , and it has important value for early screening of cervical cancer .