p16/Ki-67双染联合细胞学检测在宫颈癌前病变及宫颈癌中的筛查效果及相关因素分析

Screening effect and related factors analysis of p16/Ki-67 double staining combined with cytological detection in cervical precancerous lesions and cervical cancer

目的:探究p16/Ki-67双染联合细胞学检测在宫颈癌前病变及宫颈癌中的筛查效果及相关因素分析。方法:选取2021年6月至2023年6月大冶市人民医院收治的宫颈疾病患者200例临床资料进行回顾性分析。分析200例宫颈疾病患者病理检查结果,探讨p16/Ki-67双染、细胞学检测与两者联合在宫颈癌病变中的诊断价值,并通过Kappa值分析其与病理检查诊断的结果是否一致;并分析宫颈癌筛查影响因素。结果:经病理诊断结果显示,200例宫颈疾病患者中炎症68例、CINⅠ56例、CINⅡ34例、CINⅢ22例、宫颈癌20例。以病理检查结果作为金标准,p16/Ki-67双染检测诊断宫颈癌病变阳性的敏感度为81.58%(62/76),诊断宫颈癌病变阴性的特异性为79.84%(99/124);TCT检测诊断宫颈癌病变阳性的敏感度为77.63%(59/76),诊断宫颈癌病变阴性的特异性为78.23%(97/124);两项联合诊断宫颈癌病变阳性的敏感度为97.37%(74/76),诊断宫颈癌病变阴性的特异性为78.23%(97/124)。p16/Ki-67双染检测、TCT检测、两项联合诊断宫颈癌病变阳性与病理检查相比,Kappa值为0.597、0.545、0.711。p16/Ki-67双染与细胞学检测联合进行对宫颈癌诊断的准确性较好(100.00%、90.00%)。二元Logistic回归分析显示,年龄增长、文化程度(初中及以下)、孕次(>3次)、既往接受过宫颈检查、生殖道感染、性生活前后清洗为宫颈癌危险因素(P<0.05)。结论:p16/Ki-67双染与细胞学检测诊断宫颈癌前病变及宫颈癌具有较好效能,联合诊断价值更高,随年龄增长、文化程度(初中及以下)、孕次(>3次)、既往接受过宫颈检查、生殖道感染、性生活前后清洗为宫颈癌危险因素。

Objective:Explore the screening effect and related factor analysis of p16/Ki-67 double staining combined with cytological detection in cervical precancerous lesions and cervical cancer.Methods:A retrospective analysis was conducted on the clinical data of 200 patients with cervical diseases admitted to Dayeshi People's Hospital from June 2021 to June 2023.Analyze the pathological examination results of 200 patients with cervical diseases,explore the diagnostic value of p16/Ki-67 double staining,cytological detection,and their combination in cervical cancer lesions,and analyze their consistency with pathological examination diagnosis through Kappa value;And analyze the influencing factors of cervical cancer screening.Results:According to pathological diagnosis,among 200 patients with cervical diseases,there were 68 cases of inflammation,56 cases of CINⅠ,34 cases of CINⅡ,22 cases of CINⅢ,and 20 cases of cervical cancer.Using pathological examination results as the gold standard,the sensitivity of p16/Ki-67 double staining detection for positive diagnosis of cervical cancer lesions was 81.58%(62/76),and the specificity for negative diagnosis of cervical cancer lesions was 79.84%(99/124);The sensitivity of TCT detection for positive diagnosis of cervical cancer lesions was 77.63%(59/76),and the specificity for negative diagnosis of cervical cancer lesions was 78.23%(97/124);The sensitivity of the two combined diagnoses for cervical cancer lesions was 97.37%(74/76),and the specificity of the negative diagnosis for cervical cancer lesions was 78.23%(97/124).Compared with pathological examination,the Kappa values of p16/Ki-67 double staining test,TCT test,and combined diagnosis of cervical cancer lesions were 0.597,0.545,and 0.711,respectively.The accuracy of p16/Ki-67 double staining and cytological detection in detecting cervical cancer was good(100.00%,90.00%).Binary logistic regression analysis showed that age,education level(junior high school and below),pregnancy frequency(>3 times),previous cervical examination,reproductive tract infection,and pre and post sexual cleaning were risk factors for cervical cancer(P<0.05).Conclusion:The combination of p16/Ki-67 double staining and cytological testing has good efficacy in diagnosing cervical precancerous lesions and cervical cancer,and has higher diagnostic value.Age,educational level(junior high school or below),pregnancy frequency(>3 times),previous cervical examination,reproductive tract infection,and pre and post sexual cleaning are risk factors for cervical cancer.