TCT联合p16/Ki-67双染、HPV E6/E7 mRNA检测在宫颈鳞状上皮内病变中的诊断价值

Diagnostic value of TCT combined with p16/Ki-67 double staining and HPV E6/E7 mRNA detection in cervical squamous intraepithelial lesions

目的:探讨液基薄层细胞学检查(TCT)联合p16/Ki-67双染、HPV E6/E7 mRNA检测在宫颈鳞状上皮内病变中的诊断价值。方法:选择在郑州大学第一附属医院病理科行细胞学筛查并在1个月内行宫颈组织病理学检查的女性患者624例,年龄18~81岁,均进行了TCT、p16/Ki-67双染、HPV E6/E7 mRNA检测。对比病理学结果,评价各项检测方法单独或联合的诊断价值。结果:病理组织学结果显示624例患者中阴性(慢性炎症)183例,阳性441例(低级别鳞状上皮内病变176例、高级别鳞状上皮内病变227例、鳞状细胞癌38例);TCT阳性376例,阴性248例;p16/Ki-67双染阳性317例,阴性307例;HPV E6/E7 mRNA阳性360例,阴性264例;TCT+p16/Ki-67双染阳性425例,阴性199例;TCT+HPV E6/E7 mRNA阳性434例,阴性190例;3项联合阳性367例,阴性257例。以病理组织学结果为金标准,TCT+p16/Ki-67、TCT+HPV E6/E7 mRNA和3项联合诊断宫颈鳞状上皮内病变的敏感度分别为87.30%、89.11%、77.32%,特异度分别为78.14%、77.60%、86.34%。结论:TCT联合p16/Ki-67双染、HPV E6/E7 mRNA检测可提高宫颈鳞状上皮内病变的诊断效能。

Aim:To explore the diagnostic value of thinprep cytologic test(TCT)combined with p16/Ki-67 double staining and HPV E6/E7 mRNA detection in cervical squamous intraepithelial lesions.Methods:A total of 624 female patients aged 18~81 years who underwent cytological screening and cervical histopathology examination within 1 month in the Department of Pathology of the First Affiliated Hospital of Zhengzhou University were selected.All of them were tested for TCT,p16/Ki-67 double staining and HPV E6/E7 mRNA.Taking pathological results as the gold standard,the diagnostic value of each detection methods individually or in combination was evaluated.Results:The histopathological results showed that among 624 patients,183 were negative(chronic inflammation)and 441 were positive(176 were low-grade squamous intraepithelial lesions,227 were high-grade squamous intraepithelial lesions,and 38 were squamous cell carcinoma);376 cases were positive for TCT and 248 cases were negative;317 cases were positive for p16/Ki-67 double staining and 307 cases were negative;360 cases were positive for HPV E6/E7 mRNA and 264 cases were negative;425 cases were positive and 199 cases were negative for TCT+p16/Ki-67 double staining;434 cases were positive for TCT+HPV E6/E7 mRNA and 190 cases were negative;367 cases were positive and 257 cases were negative for combination of 3 items.The sensitivity of TCT+p16/Ki-67 double staining,TCT+HPV E6/E7 mRNA,and combination of 3 items for cervical squamous intraepithelial lesions was 87.30%,89.11%,and 77.32%,respectively,and specificity was 78.14%,77.60%,and 86.34%,respectively.Conclusion:TCT combined with p16/Ki-67 double staining and HPV E6/E7 mRNA detection can improve the diagnostic efficacy of cervical squamous intraepithelial lesions.