HPV检测、液基细胞学及p16/Ki-67三重检测在宫颈高级别病变筛查中的诊断价值研究

Diagnostic value of HPV testing,liquid-based cytology and p16/Ki-67 triple detection in screening for cervical high-grade lesions

目的探讨HPV检测、液基细胞学及p16/Ki-67三重检测在宫颈高级别病变筛查中的诊断价值。方法收集2021-2023年北京天坛医院病理科宫颈活检病例共1839例,回顾性分析HPV检测、液基细胞学(LBC)及p16/Ki-67三重检测的CIN2+检出率,并对比组间的差异,探讨高效而特异的检测方法。结果1839例宫颈活检病例中,CIN2+的总检出率为29.6%;仅HPV阳性、HPV及LBC双检阳性、HPV、LBC及p16/Ki-67三重检测阳性CIN2+检出率依次升高,分别为20.1%、32.3%、54.1%;亚组分析显示HPV16/18阳性,3组的CIN 2+检出率分别是24.4%、45.7%、70.4%;其他12种高危HPV阳性,3组的CIN 2+阳性检出率分别是14.6%、27.4%、45.3%。总体及亚组分析均显示HPV、LBC及p16/Ki-67三重检测的CIN 2+检出率最高,差异具有统计学意义(P<0.001)。结论本研究认为对于HPV阳性的女性,建议进行HPV、LBC及p16/Ki-67三重检测,提高CIN2+阳性检出率,减少漏诊,提升阴道镜的利用效率。

Objective To explore the diagnostic value of HPV testing,liquid-based cytology(LBC),and p16/Ki-67 triple testing in screening for high-grade cervical lesions.Methods A total of 1839 cases of cervical biopsies from our pathology department during the years 2021-2022 were collected.A retrospective analysis was conducted to examine the detection rates of CIN2+using HPV testing,LBC,and p16/Ki-67 triple staining.The differences between the groups were compared to identify an efficient and specific detection method.Results Among the 1839 cervical biopsy cases,the overall detection rate of CIN2+was 29.6%.The detection rates of CIN2+increased in the following order:HPV positive only(20.1%),HPV positive and LBC positive(32.3%),and HPV,LBC,and p16/Ki-67 triple positive(54.1%).Subgroup analysis showed that for HPV16/18 positive cases,the detection rates of CIN2+were 24.4%,45.7%,and 70.4%in the three groups,respectively.For the other 12 high-risk HPV types,the CIN2+positive detection rates were 14.6%,27.4%,and 45.3%in the three groups,respectively.Both overall and subgroup analyses demonstrated that the detection rate of CIN2+was highest with the HPV,LBC,and p16/Ki-67 triple staining,and the differences were statistically significant(P<0.001).Conclusion This study suggests that for women who test positive for HPV,it is advisable to perform HPV,LBC,and p16/Ki-67 triple staining to increase the detection rate of CIN2+and to reduce missed diagnoses,thereby improving the utilization efficiency of colposcopy.