三种宫颈癌联合筛查方案的对比研究

目的:研究三种宫颈癌联合筛查方案的临床价值。方法:选择江西省人民医院妇科健康体检3 280例妇女,随机分为三组:A组(1 100例)行TCT联合HPV-DNA分型检测(PCR-反向点杂交法);B组(1 080例)行巴氏涂片法联合HPV-DNA检测(PCR荧光定性);C组(1 100例)行醋酸染色(VIA)、碘液染色(VILI)肉眼观察。比较三种联合方案对宫颈病变筛查的灵敏度、特异度、阳性预测值、阴性预测值。结果:三组筛查方案的灵敏度、特异度、阳性预测值、阴性预测值分别为:A组:78.9%、98.3%、42.9%、99.6%;B组:25.0%、98%、33.3%、98.5%;C组:73.7%、91.1%、12.7%、99.5%。三组比较差异有统计学意义(P<0.05)。结论:TCT联合HPV-DNA分型检测筛查方案诊断价值优于其余两种方案,可作为宫颈癌筛查的最佳方案,适用于经济发达地区;巴氏涂片法联合HPV-DNA检测诊断准确性高,适用于一般地区;肉眼观察,简单易行,价格低廉,可在经济欠发达地区农村基层推广应用。

Comparative study on three joint screening strategies for cervical cancer

Objective:To study the clinical values of three joint screening strategies for cervical cancer.Methods:A total of 3 280 women who received physical examination in gynecological department of Jiangxi People’s Hospital were selected and randomly divided into three groups: 1 100 cases in group A received TCT combined with HPV-DNA genotyping(PCR-reverse dot blot method),1 080 cases in group B received Pap smear method combined with HPV-DNA detection(PCR fluorescence qualitative method),and 1 100 cases in group C received visual inspection after acetic acid staining and iodine staining.The sensitivities,specificities,positive predictive values,and negative predictive values of three strategies for screening of cervical lesions were compared.Results:The sensitivities,specificities,positive predictive values,and negative predictive values of three strategies for screening of cervical lesions were 78.9%,98.3%,42.9%,and 99.6% in group A,25.0%,98.0%,33.3%,and 98.5% in group B,and 73.7%,91.1%,12.7%,and 99.5% in group C,there was statistically significant difference among the three groups(P<0.05).Conclusion:The diagnostic value of TCT combined with HPV-DNA genotyping for screening of cervical cancer was higher than those of the other two strategies,which can be used as the best strategy for screening of cervical cancer,and the method is suitable for developed areas;the accuracy of Pap smear method combined with HPV-DNA genotyping for diagnosis of cervical cancer was high,which is suitable for general areas;visual inspection is simple and easy to operate,and the price is low,so it can be spread and applied in primary hospitals in rural undeveloped areas.