人乳头瘤状病毒检测与液基细胞学观察及其联合分析对宫颈癌筛查的临床意义

目的：评价人乳头瘤状病毒（HPV-DNA）检测、液基细胞学检查以及二者联合检查对宫颈癌筛查的临床诊断价值。方法：用第二代杂交捕获（HC-Ⅱ）检测和液基细胞学测试（LCT）对1200例患者进行了同步双盲法检测HPV-DNA，并以阴道镜活检组织病理结果作为最终诊断。结果：接受病理检查156例。诊断宫颈癌3例，宫颈上皮内瘤变（CIN）Ⅲ级9例、CIN-Ⅱ级19例、CIN-I级49例，其它（慢性宫颈炎和鳞状上皮化生）63例。HPV-DNA阳性率为16.8％；LCT阳性率为11.8％；HPV-DNA和LCT平行试验（任意一项阳性）的阳性率为21.2％，系列试验（两项均阳性）的阳性率为7.4％。随宫颈病变级别升高，HPV-DNA和LCT阳性率增加（P〈0.01）。HPV-DNA，LCT，二者平行试验和系列试验受试者工作特征（ROC）曲线下面积分别为0.919，0.921，0.904，0.926，各筛查试验筛查效率差异无统计学意义（P〉0.05）。结论：HPV-DNA和LCT检测常用于宫颈癌筛查，联合应用不能显著提高筛查效率，但会增加筛查成本。

Methodological evaluation of HPV-DNA and liquid-based cytology test for cervical cancer screening

AIM：To evaluate the clinical value of human papil-lomavirus （HPV） DNA test and liquid-based cytology test （LCT） and their combined analysis for cervical cancer screening. METHODS： Hybrid capture Ⅱ（HC-Ⅱ） for HPV-DNA and LCT were performed in 1200 cases by double blind method. The women with abnormal or squamous findings on colposcopy received biopsy. After biopsy under colposcopy, the results of the pathology examination was taken as the final diagnosis in screening cervical cancer. RESULTS： A total of 156 patients received biopsy in this study. Of the 156 patients, 3 were diagnosed as having cervical cancer, 9 cervical intraep ithelialneoplasia CINⅢ, 19 CINⅡ, 49 CINⅠ, and 63 other diseases （chronic cervititis and metaplasia）. The positive rates of HPV-DNA and LCT were 16.8% and 11.8%, respectively. The positive rates of HPV combined with LCT were 21.2% in parallel test and 7.4% in serial test. All the positive rates increased with the increase of cervical lesions grade （P〈0.005）. The areas under receiver operating characteristic（ROC） curves in each screening test for screening high grade cervical lesions were 0.919, 0. 921, 0. 904 and 0. 926, with no statistical differences （P〉0.05）. CONCLUSION ： Both HC-Ⅱ HPV test and LCT are valuable for screening cervical cancer. The combined detection by both HC-Ⅱ HPV and LCT will not significantly improve the detection rate in cervical cancer screening, but may increase the cost of the screening.