高危型人乳头瘤病毒DNA检测在宫颈癌筛查中的作用

目的:探讨高危型人乳头瘤病毒(HPV)DNA检测在宫颈癌筛查中的作用。方法:2005年4月~2006年4月在我院妇科门诊就诊2 340名妇女进行宫颈癌前病变筛查,采用第2代杂交捕获试验(HC-Ⅱ)检测高危型HPV DNA联合薄层液基细胞学检查,同时进行阴道镜检查,并以宫颈活检的组织病理学为确诊标准。结果:筛查并经病理诊断为HPV感染365例,宫颈上皮内瘤变(C IN)Ⅰ级71例,C INⅡ48例,C INⅢ55例,宫颈浸润癌31例。以组织病理学为确诊标准,高危型HPV DNA检测C INⅡ、C INⅢ的敏感度是91.33%,特异度是74.51%,阳性预测值是5.21%,阴性预测值是99.79%。宫颈细胞学筛查C INⅡ、C INⅢ,以未明确诊断意义的不典型鳞状上皮细胞(ASCUS)为分界点的敏感度、特异度、阳性预测值、阴性预测值分别是90.80%、80.45%、12.30%、99.50%;以高度鳞状上皮内病变(HSIL)为分界点的敏感度、特异度、阳性预测值、阴性预测值分别是98.90%、73.98%、4.90%、100.00%。高危型HPV DNA在不同宫颈病变中的阳性率分别是:宫颈癌88.57%(31/35),C INⅢ91.67%(66/72),C INⅡ87.50%(56/64),C INⅠ42.00%(21/50)。结论:高危型人乳头瘤病毒DNA检测在宫颈癌前病变的筛查中有很高的敏感度和阴性预测值,高危型HPV DNA联合细胞学检查可使敏感度和阴性预测值有提高,但特异度未能提高。

The role high- risk human papillomavirus DNA test and cytological detection in cervical cancer screening

Objective:To investigate the effect of highrisk human papillomavirus(HPV) DNA test and cytological detection for primary screening on cervical cancer.Methods:From April 2005 to April 2006,a total of 2 340 women were screened by combining high-risk HPV DNA test(hybrid capture Ⅱ,HC-Ⅱ) and cytological test(liquid-based ThinPrep cytology test),and the abnomal cytological or HPV DNA findings were further biopsied under the colposcope.Results:Final pathological diagnosis was HPV infection in 365 cases,cervical intraepithelial neoplasia(CIN)Ⅰin 71 cases,CIN Ⅱ in 48 cases,CIN Ⅲ in 55 cases,invasive cervical cancer 31 cases.Based on the criteria of histology and pathology,the sensitivity,specificity,positive-predictive and negative-predictive value of high-risk HPV DNA test for detecting all cases of CINⅡ,CIN Ⅲ were 91.33%,74.51%,5.21% and 99.79%.In detecting all cases of CINⅡ,Ⅲ by cytological test,for atypical squamous cell of undetermined signification(ASCUS),the sensitivity,specificity,positive-predictive value and negative-predictive value were 90.80%,80.45%,12.30% and 99.50% respectively;for low-grade squamous intraepithelial lesion(LSIL),the sensitivity,specificity,positive-predictive and negative-predictive value were 69.98%,90.60%,11.09% and 99.49% respectively;for high-grade squamous intraepithelial lesion(HSIL),the sensitivity,specificity,positive-predictive and negative-predictive value were 49.01%,98.64%,29.20% and 99.31% respectively.By the combination of highrisk HPV DNA test and cytological test,the sensitivity,specificity,positive-predictive and negative-predictive value for deteciting all cases of CINⅡ,Ⅲ were 98.90%,73.98%,4.90% and 100.00% respectively.The infection rate of HPV in cervical cancer was(88.57%)(31/35),in CIN Ⅲ 91.67%(66/72),in CINⅡ 87.50%(56/64) and in CINⅠ42.00%(21/50).Conclusion:High-risk HPV DNA test has high sensitivity and negative-predictive value.The combination of high-risk HPV DNA test and cytological test increases the sensitivity and negative-predictive value,but it does not increase the specificity.The performance of biopsy under the colposcope can help the diagnosis of cervical dysplasia.