液基细胞学检查结合人乳头瘤病毒检测在绝经后女性宫颈癌机会性筛查中的应用价值

Application value of thin-prep cytology test combined with human papilloma virus detection in the opportunistic screening of cervical cancer in postmenopausal women

目的探讨液基细胞学检查(TCT)结合人乳头瘤病毒(HPV)检测在绝经后女性宫颈癌机会性筛查中的应用价值。方法选取2022年6月至2023年6月在吉林医药学院附属医院妇科门诊接受诊治的1022例绝经后妇女为研究对象,分别进行TCT、阴道镜组织检查和HPV检查,以阴道镜组织检查为金标准,采用ROC分析评价TCT、HPV与二者联合对绝经后宫颈癌的诊断效能。结果1022份TCT检测样本中,TCT结果为正常或炎症反应919例(89.9%),而TCT检查异常者103例(10.1%)。阴道细胞学的分类及报告系统(TBS)报告为非典型鳞状上皮细胞(ASC-US)53例(51.5%),低度鳞状上皮内瘤变(LSIL)23例(22.3%),高度鳞状上皮内瘤变(HSIL)21例(20.4%),鳞状细胞癌(SCC)6例(5.8%)。阴道镜组织病理结果显示,炎症反应34例(33.0%),上皮内瘤变(CIN)Ⅰ37例(35.9%);CINⅡ16例(15.5%);CINⅢ11例(10.7%),SCC 5例(4.9%)。TCT检查异常者中有69例(66.9%)为阴道镜检查异常,TCT结果与病理学结果总体符合率为56.3%(58/103)。随着TBS分类级别越高,HPV阳性率越高,HSIL组和SCC组的HPV阳性率高于LSIL组和ASC-US组,差异有统计学意义(P<0.05)。ROC分析结果显示,TCT诊断的AUC高于HPV,为0.785(95%CI:0.694~0.895),敏感度较高的是TCT检查,但是特异度较高的是HPV检测。二者联合诊断的AUC进一步提高,为0.813(95%CI:0.723~0.924),敏感度和特异度分别是84.3%和88.5%。结论HPV检查结合TCT检查在绝经后女性宫颈癌机会性筛查中具有重要应用价值,建议临床加以推广。

Objective To explore the application value of thin-prep cytology test(TCT)combined with human papilloma virus(HPV)detection in the opportunistic screening of cervical cancer in postmenopausal women.Methods A total of 1022 postmenopausal women who were diagnosed and treated in the Gynecological Clinic of the Jilin Medical University Affiliated Hospital from June 2022 to June 2023 were selected as the research objects.The TCT,colposcopy tissue examination and HPV test were performed respectively.ROC analysis was used to evaluate the diagnostic efficacy of TCT,HPV and their combination for postmenopausal cervical cancer.Results Through 1022 TCT test samples,919 cases(89.9%)showed normal or inflammatory response in TCT results,while 103 cases(10.1%)showed abnormal TCT results.The TBS diagnostic system reported 53 cases(51.5%)of ASC-US,23 cases(22.3%)of LSIL,21 cases(20.4%)of HSIL,and 6 cases(5.8%)of squamous cell carcinoma(SCC).The pathological results of vaginal endoscopy showed that there were 34 cases(33.0%)of inflammatory reactions,and 37 cases(35.9%)of CINⅠ;There were 16 cases(15.5%)of CINⅡ;There were 11 cases of CINⅢ(10.7%)and 5 cases of SCC(4.9%).Among the patients with abnormal TCT examination,69 cases(66.9%)had abnormal colposcopy examination,and the overall coincidence rate of TCT results and pathological results was 56.3%(58/103).As the TBS classification level increases,the HPV positivity rate also increases,with statistically significant differences(P<0.05).The ROC analysis results show that the AUC diagnosed by TCT was higher than that of HPV,with a value of 0.785(95%CI:0.694-0.895).The TCT test was more sensitive,but the HPV test was more specific.The AUC of the combined diagnosis of the two was further increased to 0.813(95%CI:0.723-0.924),with sensitivity and specificity of 84.3%and 88.5%,respectively.Conclusion HPV test combined with TCT examination has important application value in the opportunistic screening of cervical cancer in postmenopausal women,and it is recommended to be popularized in clinical practice.