318例高级别宫颈上皮内瘤变及宫颈癌患者的TCT和hrHPV检测分析

目的:探讨如何使用现有的筛查方法,减少高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia grade 2 or 3,CIN2/3)及宫颈癌的漏诊。方法:回顾性分析2014年6月至2018年8月318例中国医科大学附属航空总医院治疗的CIN2/3及宫颈癌患者的临床资料,其中CIN2/3为296例、宫颈癌为22例,采用宫颈液基薄层细胞学检查(thinprep cytology test,TCT)及高危型人乳头瘤病毒(high risk human papilloma virus,hrHPV)检测方法,分析患者的年龄、TCT和hrHPV。结果:296例CIN2/3患者中30～39岁患者为130例(43.92%)、占第1位,20～29岁年轻患者为69例(23.31%)、占第3位。318例患者中TCT阳性为199例(62.58%),hrHPV阳性为308例(96.86%),两者联合筛查阳性为313例,阳性率为98.43%(313/318)。hrHPV分型检测主要亚型依次为16、52、58、33、18、31型。结论:CIN2/3及宫颈癌的发病年龄年轻化,年轻患者筛查不容忽视。TCT单独筛查较hrHPV单独筛查易漏诊高级别病变,TCT联合hrHPV筛查可提高检出率。TCT阴性,hrHPV非16、18亚型的其他hrHPV阳性,尤其是hrHPV52、58、33、31亚型阳性患者也建议行阴道镜检查。

TCT and hrHPV analysis of 318 cases with high-grade cervical intraepithelial neoplasia and cervical cancer

  Objective  To identify appropriate ways of applying the current cervical screening methods to minimize the occurrence of missed diagnosis of high-grade cervical intraepithelial neoplasia (CIN2/3) and cervical cancer.  Methods  A retrospective analysis was conducted based on the clinical data of 318 patients, who had CIN2/3 or cervical cancer and were treated in Aviation General Hospital Affiliated to China Medical University between June 2014 and August 2018. Among these cases, 296 involved CIN2/3, and 22 involved cervical cancer. All of the patients involved underwent a thinprep cytology test (TCT) and high-risk human papilloma virus (hrHPV) screening, and their age and TCT and hrHPV results were further analyzed.  Results  Among the 296 patients diagnosed with CIN2/3, 130 of them (43.92%) were aged between 30 and 39 years, ranking the top among all age groups. Sixty-nine young patients (23.31%) aged between 20 and 29 years were diagnosed with CIN2/3, ranking in the third place. Among all of the 318 cases, the TCT results were positive in 199 cases (62.58%), hrHPV results were positive in 308 cases (96.86%), and there were 313 cases (98.43%, 313/318) wherein both TCT and hrHPV results were positive according to joint screening. The most predominant hrHPV subtypes were 16, 52, 58, 33, 18, and 31.  Conclusions  As an increasing number of young women are diagnosed with CIN2/3 and cervical cancer, their screening should not be ignored. Single use of TCT screening leads to more frequent missed diagnosis of high-grade lesions compared with single use of hrHPV screening, while joint use of both screening methods could improve the detection rate. Even if TCT results were negative, it is suggested to conduct a colposcopy for those patients with high-risk subtypes besides hrHPV16 and 18 positivity, and in particular, for patients with hrHPV 52, 58, 33, and 31 positivity.