高危型人乳头状瘤病毒DNA检测联合液基细胞学检查在宫颈病变筛查中的价值

目的:评价高危型人乳头状瘤病毒(HPV)DNA检测联合宫颈液基细胞学检查在宫颈病变筛查中的价值。方法:采用宫颈超薄液基细胞学检测及第二代杂交捕获试验(HC-Ⅱ)对14 861例妇女进行宫颈病变筛查,以宫颈组织病理学检查结果作为确诊的金标准。结果:HR-HPV感染3 595例,感染率24.19%;细胞学检查发现非典型鳞状细胞202例,非典型腺细胞1例,LSIL303例;HSIL92例;病理学证实CINⅠ90例、CINⅡ65例、CINⅢ86例、宫颈鳞状细胞癌7例、腺癌2例。高危型HPV DNA在不同宫颈病变中的阳性率分别是:HSIL 92.05%(139/151)、LSIL 52.22%(47/90)和无宫颈上皮病变26.70%(25/939),各组间比较有显著性差异。高危型HPV DNA检测CIN的敏感度是91.05%,特异度是81.35%,阴性预测值为99.55%。宫颈液基细胞学筛查CIN的敏感度、特异度和阴性预测值分别是88.92%、95.56%和99.20%。高危型HPV DNA检测联合细胞学检查筛查CIN的敏感度、特异度和阴性预测值分别是96.12%、82.56%和100.00%。结论:高危型HPVDNA检测在宫颈癌的筛查中有很高的敏感度和阴性预测值,高危型HPV DNA检测联合细胞学检查可使敏感度和阴性预测值有所提高,其结果对宫颈病变有预警作用。

The value of high-risk human papillomavirus DNA test and Thinprep liquid based cytology for the screening of cervical lesions

Objective:To evaluate the significance of high-risk human papillomavirus(HPV) DNA test and Thinprep liquid based cytology for the screening of cervical lesions.Methods:14 861 women were monitored by Thinprep liquid based cytology and hybrid capture Ⅱ,taking biopsy pathology result as golden standard.Results:In 14 861 women,3 595(24.19%) were positive for HR-HPV DNA.By Thinprep liquid based cytology,ASCUS/AGCUS,LSIL and HSIL were found in 202,303 and 92 women,respectively.By biopsy under the celposcope,90,65 and 86 women were diagnosed as CIN Ⅰ,CIN Ⅱ and CIN Ⅲ,respectively,while 7 women were diagnosed as squamous cervical cancer and 2 cervical adenocarcinoma;939 women were negative for intraepithelial lesion or malignancy.The positive rate of HR-HPV was 52.22%(47/90) in CIN Ⅰ,92.05%(139/151) in CINIⅡ/Ⅲ,and 26.7% in NILM.The sensitivity,specificity and negative predictive values of HR-HPV were 91.05%,81.35% and 99.55%,respectively.For Thinprep liquid based cytology,the sensitivity,specificity and negative predictive values were 88.92%,95.56% and 99.20%,respectively.Additionally,the sensitivity,specificity and negative predictive values were 96.12%,82.56% and 100% by HR-HPV combined Thinprep liquid based cytology.Conclusion:Combining Thinprep liquid based cytology with HR-HPV DNA test may increase the sensitivity and negative predictive value for detecting cervical lesions.