高危型HPV和TCT检测在宫颈高度上皮内病变行LEEP治疗后随访中的价值

目的:探讨HR-HPV和TCT检测在高度CIN行LEEP治疗后检测病变残余或复发的价值。方法:98例CINⅡ和CINⅢ患者行LEEP治疗后第3、6、12、24个月均检测HR-HPV和TCT及阴道镜,病理证实存在CIN视为残留或复发。结果:①术后第6个月HR-HPV转阴率较术后3月明显升高(P<0.05),且术后第6个月时HR-HPV检测诊断病变残留/复发的指标均较术后第3、12、24个月时高。②术后第6个月HR-HPV阳性23例,其中发病14例,阴性患者无发病;HR-HPV诊断病变残留或复发的敏感度、特异度、阳性预测值、阴性预测值、一致率、Youden值分别为100.00%、89.29%、60.87%、100.0%、90.82%、0.892 9,TCT检测分别为64.29%、94.05%、64.29%、94.05%、89.80%、0.583 4;HR-HPV敏感度和阴性预测值优于TCT。③术后病理切缘阳性16例(16.33%),术后24个月残留/复发28例(28.57%),切缘阳性残留/复发率(56.3%)较阴性患者(23.2%)发生率明显升高(P=0.013),发生风险是阴性患者的4.3倍;切缘阳性术后6月HPV阳性率(50.0%)较切缘阴性者(18.3%)亦明显升高(P=0.011),风险是阴性患者的4.5倍;而手术切缘阳性和术后6月TCT阳性率之间无明显相关性(P=0.695)。结论:术后第6个月HR-HPV检测是LEEP术后病变残留/复发的敏感指标,与TCT联合应用可提高敏感度,降低漏诊率。此外手术切缘阳性者术后病变残留/复发和HPV阳性发生率明显增高。

Values of high risk HPV detection and Thin Prep cytologic test for follow-up of patients with high-grade cervical intraepithelial neoplasia after LEEP

Objective:To explore the values of high risk human papillomavirus(HR-HPV) detection and Thin Prep cytologic test(TCT) for detecting residual lesions and recurrence among patients with high-grade cervical intraepithelial neoplasia(CIN) after loop electrosurgical excision procedure(LEEP).Methods:Ninety-eight patients with CIN Ⅱ and CIN Ⅲ received HR-HPV detection,TCT,and colposcopy at 3,6,12,and 24 months after LEEP,CIN confirmed by pathological examination was designed as residual lesions or recurrence.Results:HR-HPV negative conversion rate at 6 months after LEEP was statistically significantly higher than that at 3 months after LEEP(P<0.05),HR-HPV diagnostic indexes of residual lesions or recurrence at 6 months after LEEP were higher than those at 3,12,and 24 months after LEEP.At 6 months after LEEP,23 cases with positive HR-HPV were found,and 14 cases were diagnosed as residual lesions or recurrence,and none was detected with negative HR-HPV;the sensitivity,specificity,positive predictive value,negative predictive value,coincidence rate,and Youden value of residual lesions or recurrence diagnosed by HR-HPV were 100.00%,89.29%,60.87%,100.0%,90.82%,and 0.892 9,respectively;the sensitivity,specificity,positive predictive value,negative predictive value,coincidence rate,and Youden value of residual lesions or recurrence diagnosed by TCT were 64.29%,94.05%,64.29%,94.05%,89.80%,and 0.583 4,respectively,the sensitivity and negative predictive value of HR-HPV were higher than those of TCT.After operation,16 cases(16.33%) were found with positive incision margin,28 cases(28.57%) were found with residual lesions or recurrence at 24 months after operation,the residual rate/recurrence rate in cases with positive incision margin was 56.3%,which was higher than that in cases with negative incision margin(23.2%)(P=0.013),the former was 4.3 times more than the latter;at 6 months after operation,HPV positive rate in cases with positive incision margin was 50.0%,which was higher than that in cases with negative incision margin(18.3%)(P=0.011),the former was 4.5 times more than the latter;but there was no correlation between positive incision margin and TCT positive rate at 6 months after operation(P=0.695).Conclusion:High risk HPV detection is a sensitive index of residual lesions and recurrence of CIN after LEEP,and high risk HPV detection combined with TCT can improve sensitivity and reduce missed diagnostic rate.The residual rate/recurrence rate and HPV positive rate in cases with positive incision margin increase significantly.