宫颈疾病液基细胞学和人乳头状瘤病毒脱氧核糖核酸联合检测及与组织学检查的对照研究

A Study of Thinprep Cytologic Test Combined with Human Papilloma Virus Hybrid CaptureⅡ DNA Test and Biopsy-Control in Cervical Lesions

目的:探讨薄层液基细胞学技术(TCT)联合第2代杂交捕获乳头状瘤病毒核酸检测(HCII HPV DNA)检测诊断宫颈病变的价值,并总结TCT诊断中漏诊、误诊的原因。方法:收集上海市长宁区中心医院2006—2009年行TCT、HCII HPVDNA检测及阴道镜活检的病例共1050例,分别比较了TCT、HCII HPV DNA及TCT联合HCII HPV DNA检测的诊断效能。对照组织病理学诊断结果,分析了TCT漏诊、误诊的原因。结果:TCT中低度鳞状上皮细胞内病变(LSIL)/高度鳞状上皮细胞内病变(HSIL)与组织学的符合率显著高于未见癌细胞或癌前病变细胞(NILM)/不能明确意义的非典型鳞状上皮细胞(ASUCS),P<0.01;人乳头状瘤病毒(HPV)感染率随病变程度加重而逐步增加(P<0.01);TCT联合HCII HPV DNA检测的敏感性、阴性预测值均显著提高(P<0.01);TCT诊断假阳性的原因主要是对反应性细胞及变性细胞的误诊,而假阴性的原因则是对个别挖空细胞和异形细胞的漏诊。结论:TCT联合HCII HPV DNA检测可以显著提高宫颈病变诊断效能,有助于宫颈癌的早期预防、早期发现、早期治疗。正确的取材、规范的制片、准确的识别反应性细胞、挖空细胞和核深染的异形细胞,将有效地减少假阳性和假阴性率。

Objective：To investigate the value of thinprep cytologic test（TCT） combined with human papilloma virus（HPV） Hybrid Capture II（HPV HCII） test in cervical intraepithelial neoplasia and summarize the reasons for misinterpreting/missing diagnosis.Methods：Patients（n=1050） with TCT,HCII HPV test and routine biopsy under colposcopy encountered between 2006-2009 in Shanghai Changning District hospital.According to cervical biopsy diagnosis,we analyzed the causes of false-positive and false-negative in TCT diagnosis and compared the diagnostic efficiency among TCT,HCII HPV test,TCT combined with HCII HPV test.Results： The rates of（LSIL/HSIL） accordance with biopsy were higher than（NILM/ASCUS）,P〈0.01.HPV infection was increased with the degree of cervical lesions（P〈0.01）.The sensitivity and negative predictive value were significantly higher for TCT combined with HCII HPV DNA than TCT alone（P〈0.01）.The causes of false-positive in TCT diagnosis were mainly for misinterpreting reactive cells and regressive cells while false-negative were mainly for missing individual koilocyte and dysplastic cell.Conclusions： TCT combined with HCII HPV test evidently enhance diagnostic efficiency which will play a positive role in the early preventation,detection and treatment of cervical carcinoma.False-positive and false-negative will be effectively decreased by means of accurate sampling,regular procession and exact recognization of reactive cell,koilocyte and hyperchromaticly dysplastic cell.