高危型人乳头瘤病毒检测在宫颈细胞学异常患者中的分流作用

目的 探讨高危型人乳头瘤病毒(HPV)对宫颈细胞学异常患者的分流作用.方法 对694例宫颈细胞学异常患者进行了高危型HPV检测,并对宫颈液基薄层细胞学(TCT)检测异常患者进行了分析.其中275例患者同时行阴道镜检查及宫颈多点活检.将275例患者分为不典型鳞状细胞(ASC)组、低度鳞状上皮内病变(LSIL)组和高度鳞状上皮内病变(HSIL)组,每组分别为71例、149例和55例.结果 在694例患者中,细胞学为ASC、LSIL和HSIL时hrHPV阳性率分别为68.4%(252/368)、87.6%(219/250)和93.4%(71/76).在275例进行了阴道镜和宫颈活检的患者中,细胞学为ASC、LSIL和HSIL时,组织学为CIN2+的比例分别为22.5%、30.2%和70.9%,组织学为CIN3+的比例分别为7.0%、12.2%和36.4%.以CIN2+为终点时,高危型HPV检测在ASC组的敏感性、特异性分别为93.8%、23.6%,LSIL组为93.1%、10.6%,HSIL组为97.4%、25.0%;以CIN3+为终点时,ASC组的敏感性、特异性、阳性预测值和阴性预测值分别为100%、21.2%,LSIL组为100%、10.7%,HSIL组为95.0%、11.4%.结论 高危型HPV感染与宫颈癌前病变及子宫颈癌密切相关,对细胞学为ASC的患者可作为有效的分流方法减少进行阴道镜检查的患者比例;但对宫颈细胞学为LSIL和HSIL时,其分流的意义不大,对此类患者均应进行阴道镜检查.

Triage value of high risk human papilloma virus detection in women with abnormal cervical cytology

OBJECTIVE: To evaluate the triage value of high risk human papilloma virus (hrHPV) detection in the women with abnormal cervical cytology. METHODS: 28,650 women underwent thinprep cell test (TCT) to screen cervical cancer. 694 of the 2433 patients with abnormal cervical cytology were randomly selected to undergo hrHPV HC II test to detect high risk HPV. 275 of these 694 patients received colposcopy and biopsy, 71, 149, and 55 of which were diagnosed as with atypical squamous cell (ASC), low squamous intraepithelial lesion (LSIL), and high squamous intraepithelial lesion (HSIL) respectively. The triage value of hrHPV detection was analyzed. RESULTS: Among the 694 patients, the incidence rates of hrHPV infection of those with ASC, LSIL, and HSIL were 68.4% (252/368), 87.6% (219/250), and 93.4% (71/76) respectively. Among the 275 cases who received colposcopy and biopsy the percentages of histopathologic lesion CIN2 in those with ASC, LSIL, and HSIL were 22.5%, 30.2%, and 70.9% respectively. When with CIN2 + as terminal, the sensitivity and specificity of hrHPV test were 93.8% and 23.6% in the ASC group; 93.1% and 10.6% in the LSIL group, and 97.4% and 25.0% in the HSIL group. Histopathologic lesions CIN3 or worse were seen in 7.0% of the patients with ASC, 12.2% of the patients with LSIL, and 36.4% of the patients with HSIL. When with CIN3 + as the terminal the sensitivity and specificity of hrHPV test were 100% and 21.2% in the ASC group; 100% and 10.7% in the LSIL group; and 95.0% and 11.4% in the HSIL group. CONCLUSION: hrHPV infection is associated with preinvasive cervical cancer and invasive cervical cancer. hrHPV test is a good triage approach for the patients with ASC, able to decrease about 50% of colposcopic referral. For the patients with LSIL and HSIL, hrHPV test is not an appreciate triage test and immediate colposcopy is recommended.