薄层液基细胞学检查及人乳头瘤病毒检测在宫颈癌筛查中的应用价值

目的探讨薄层液基细胞学(thinprep cytololgy test,TCT)检测及高危型人乳头瘤病毒(human papillomavirus,HPV)检测在宫颈癌初筛中的不同临床应用价值。方法选择2012年10月—2013年10月自愿参加"两癌"筛查的青岛市崂山区户籍妇女1 568名,所有对象同时进行TCT检测和HPV分型检测,检出阳性病例均在电子阴道镜下行宫颈病理活检。计数资料采用χ2检验,P0.05为差异有统计学意义。结果 1 568例受检者中,TCT阳性236例,病理活检为宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)及以上者150例,符合率为63.56%。随着其细胞学分级的增高,组织学符合率逐渐升高。HPV阳性512例,病理活检为CIN及以上者180例,符合率为35.16%。比较差异有统计学意义(P0.05)。126名液基细胞学检测结果为非典型鳞状上皮意义不明确(atypical squamous cell of undermined significance,ASCUS)HPV阳性者病理符合率为61.76%,阴性者病理符合率为27.59%,HPV阳性者病理符合率高于阴性者,比较差异有统计学意(P0.05)。且随着病变程度的加深,HPV感染率逐渐升高。结论与HPV病毒检测相比,TCT检测的组织学诊断符合率更高,特别是对于TCT检测结果为HSIL者;对于TCT检测结果为ASCUS者,HPV病毒检测可以起到有效的分流管理作用。

Clinical value of thinprep cytology test and human papillomavirus detection in cervical cancer screening

Objective To discuss the clinical value of thinprep cytology test（TCT） and human papillomavirus（HPV） detection in cervical cancer screening.Methods From October 2012 to October 2013,a total of 1 568 women volunteering for two cancer screening were selected from Laoshan district of Qingdao city.TCT and detection of HPV type were conducted simultaneously.The detected positive cases underwent colposcopy and cervical biopsyx~ test was used for count data,the result of P〈0.05 was considered statistically significant.Results Of 1 568 cases,236 positive cases were detected by TCT,150 cases of CIN1 or greater by pathology,the coincident rate was 63.56%.With the increase of cytological classification,histological coincidence rate gradually increased.There were 512 HPV positive cases,of which, 180 were CIN1 or greater, the coincident rate of histology was 35.16%.There was statistically significant difference between two methods（P〈0.05）.Of 126 ASCUS cases detected by TCT,the coincident rate of histology was 61.76% for HPV positive cases,and 27.59% for HPV negative cases,which showed significant difference（P〈0.05）. The rate of HPV infection increased with the severity of lesions.Conclusion Compared with HPV detection,TCT shows a higher coincident rate of histology,especially for high-grade squamous intraepithelial lesions（HSIL）.HPV-DNA test is an effective method for the distribution and management of ASCUS patients.