鳞状上皮细胞癌抗原联合人乳头瘤病毒DNA检测对非典型鳞状上皮细胞的诊断意义

SCC detection and HPV DNA testing in ASCUSS patient

目的探讨检测人乳头瘤病毒(HPV)、血清肿瘤标志物鳞状上皮细胞癌抗原(SCC)在非典型鳞状上皮细胞(ASCUS)病人分流管理中的意义。方法对病人宫颈液基细胞学(TCT)检查诊断为ASCUS,并同时进行HPV DNA、血清SCC检测和阴道镜检下定位活检的175例病人,以病理学结果为确诊标准,进行回顾性分析。同时,选取同期体检健康女性50例为对照组,HPV和SCC均阴性。结果175例ASCUS病人,病理活检炎症或正常133例,宫颈上皮细胞瘤变(CIN)Ⅰ28例,CINⅡ/Ⅲ12例,宫颈鳞状细胞癌2例。HPV DNA阳性对于CINⅡ及以上的检出率为16.00%(12/75),显著高于HPV DNA阴性病例检出率2.00%(2/100),差异有统计学意义(P<0.05),且随着宫颈上皮细胞瘤变(CIN)级别的增加,HPV阳性率越高。而血清SCC含量大于>1.5 ng/m L组与血清SCC≤1.5 ng/m L组对于CINⅡ及以上的检出率分别为37.50%(6/16)、5.03%(8/159),两者差异有统计学意义(P<0.05)。HPV DNA检测对于预测CINⅡ及以上病理结果的敏感度、特异度、阴性预测值及阳性预测值分别为85.71%、60.87%、98.00%、16.00%;血清SCC检测对于预测CINⅡ及以上病理结果的敏感度、特异度、阴性预测值及阳性预测值分别为42.86%、93.79%、94.97%、37.50%;二者联合检测应用预测宫颈癌高级别病变的敏感度、特异度、阴性预测值及阳性预测值分别为92.86%、57.76%、98.94%、16.05%。结论单独HPV DNA或血清SCC检测对于ASCUS病人分流具有一定意义,两者联合检测可有效提高宫颈癌高级别病变的敏感性,减少宫颈癌高级别病变的漏诊和不必要的活检,能在早期有效分流管理ASCUS人群。

Objective To investigate the significance of human papilloma virus(HPV)testing and serm squamous cell carcinoma antigen(SCC)in the patients with atypical squamous cell of undermined significance(ASCUS).Methods Retrospectively analysis of 175 patients diagnosed as ASCUS by Thin Prep cytology test(TCT),HPV DNA test and pathology examination were analyzed at the same time.50 cases of healthy women were included in control group,HPV and SCC were negative.Results 175 patients with ASCUS,133 cases of pathological biopsy inflammation or normal,28 cases of CINⅠ,12 cases of CINⅡ/Ⅲand 2 cases of cervical squamous cell carcinoma.The positive rate of HPV DNA for detecting CINⅡand above was 16.00%(12/75),which was significantly higher than that of HPV DNA negative cases 2.00%(2/100),statistically significant(P<0.05).And as the level of cervical intraepithelial neoplasia(CIN)increased,the positive rate of HPV.The detection rates of CINⅡand above in serum SCC>1.5 ng/m L group and serum SCC≤1.5 ng/m L group were 37.50%(6/16)and 5.03%(8/159)respectively,statistically significant(P<0.05).The sensitivity,specificity,negative predictive value and positive predictive value of HPV DNA test and serum SCC for predicting CINⅡand above were 85.71%and 42.86%,60.87%and 93.79%,98.00%and 94.97%,16.00%and 37.50%,respectively.The sensitivity,specificity,negative predictive value and positive predictive value of combined detection of the two in the detection of high-grade cervical cancer were 92.86%,57.76%,98.94%and 16.05%respectively.Conclusion The detection of single HPV DNA or serum SCC has some significance for the shunting of ASCUS patients.The combination detection of HPV DNA and serum SCC can effectively improve the sensitivity of high-grade cervical lesions and reduce the missed diagnosis of high-grade cervical lesions and reduce unnecessary pathological diagnosis,which can be effective in early stage Shunt management ASCUS crowd.