液基细胞学结合高危型HPV检测在宫颈病变筛查中的应用

目的 探讨超薄液基细胞学(LCT)结合高危型人乳头状瘤病毒(HR-HPV)检测在宫颈病变筛查中的作用.方法 回顾性分析4264例行LCT检查的患者,其中621例结果为意义不明的不典型鳞形细胞(ASCUS)及以上患者同时行HR-HPVDNA检测和阴道镜检查并活检,分析2种方法对诊断宫颈病变的临床意义.结果 将细胞学结果与组织学结果作对比分析,细胞学异常的621例样本中ASCUS 388例,低度鳞状上皮内瘤变(LSIL)147例,高度鳞状上皮内瘤变(HSIL)75例,鳞状上皮细胞癌(SSC)11例.细胞学与病理诊断符合率分别为LSIL 72.41%(147/203),HSIL 92.60%(75/81),SCC 100%(11/11).621例ASCUS异常患者中HPV感染率43.32%(269/621),HPV在不同宫颈病变中的阳性率分别是:宫颈癌100.00%(11/11),宫颈上皮瘤样增生(CIN)Ⅲ 84.85%(28/33),CIN Ⅱ 70.83%(34/48),CIN Ⅰ 84.073(172/203),正常或炎症7.32%(24/326),高危型HPV感染阳性率随宫颈病变程度加重而明显升高.LCT检查的敏感性为81.04%,特异性为91.64%;HR-HPV检测的敏感性为90.47%,特异性为93.14%.结论 液基细胞学(LCT)结合高危型人乳头状瘤病毒(HPV)检测提高了宫颈病变诊断的敏感度和特异度,是防治宫颈癌的关键.

Application of liquid-based cytology and high-risk human papillomavirus DNA detection in cervical lesion screening

OBJECTIVE: To explore the application of liquid-based cytology test (LCT) and high-risk human papillomavirus (HR-HPV) DNA test in cervical lesion screening. METHODS: A retrospective analysis was conducted in 4264 patients with LCT, among whom 621 patients had colposcopic biopsy and HR-HPV test for atypical squamous cells of undetermined significance (ASCUS and over). RESULTS: Of the 621 patients, 388 were identified to have ASCUS, 147 had low-grade squamous intraepithelial lesions (LSIL), 75 had high-grade squamous intraepithelial lesions (HSIL) and 11 had squamous cell carcinomas (SCC). Comparison of the diagnostic results of LCT and histopathology diagnosis suggested a rate of agreement of 72.41% (147/203) for LSIL, 92.60% (75/81) for HSIL, and 100% (11/11) for SCC. The infection rate of HR-HPV was 43.32%(269/621) in the 621 patients, 100.00% (11/11) in SCC patients, 84.85% (28/33) in CIN III patients, 70.83% (34/48) in CIN II patients, 84.073 (172/203) in CIN I patients, 7.32% (24/326) in patients with normal cervix/cervicitis, indicating increased rate of HR- HPV infection with aggravation of cervical lesion. The sensitivity and specificity of LCT test were 81.04% and 91.64% respectively, and those of HR-HPV were 90.47% and 93.14 respectively. CONCLUSION: The combination of LCT and HR-HPV DNA test increases the sensitivity and specificity of diagnosis in cervical dysplasia, and may help in better prophylaxis and treatment of cervical carcinoma.