高危型HPV-DNA分型联合TCT及阴道镜检查在宫颈癌前病变早期筛查中的价值

Value of High-risk HPV-DNA Typing Combined with TCT and Colposcopy in the Early Screening of Cervical Precancerous Lesions

目的:探讨高危型人乳头状瘤病毒(HPV)脱氧核糖核酸(DNA)分型联合薄层液基细胞检查(TCT)及阴道镜检查在宫颈癌前病变早期筛查中的临床价值。方法:回顾性分析2019年1月至2022年1月中山大学附属第一医院惠亚医院收入的宫颈癌前病变患者100例,以及慢性宫颈炎患者60例,对两组患者均进行高危型HPV-DNA分型、TCT以及阴道镜检查,以病理检查结果作为金标准,分析高危型HPV-DNA分型检测、TCT以及阴道镜检查三种检查方案单项以及联合检测的诊断效能,并比较差异。结果:高危型HPV-DNA分型+TCT+阴道镜诊断宫颈癌前病变的灵敏度为98.00%(98/100),特异度为38.33%(23/60),准确率为75.62%(121/160);高危型HPV-DNA分型+TCT+阴道镜灵敏度高于高危型HPV-DNA分型、TCT、阴道镜单项检查;TCT+阴道镜、高危型HPV-DNA分型+阴道镜、高危型HPV-DNA分型+TCT、阴道镜、高危型HPV-DNA分型灵敏度均高于TCT单项检查;高危型HPV-DNA分型+阴道镜、高危型HPV-DNA分型+TCT灵敏度均高于阴道镜检查,差异均具有统计学意义(P<0.05);高危型HPV-DNA分型+TCT+阴道镜、TCT+阴道镜、高危型HPV-DNA分型+阴道镜、高危型HPV-DNA分型+TCT、阴道镜、高危型HPV-DNA分型准确度高于TCT单项检查,差异均具有统计学意义(P<0.05);而其他检查方案间的准确度比较,差异均无统计学意义(P>0.05);不同检查方案间特异度、阳性预测值及阴性预测值比较,差异均无统计学意义(P>0.05)。结论:宫颈癌前病变早期筛查中应用高危型HPV-DNA分型、TCT、阴道镜检查三者联合检查,相较于单项检查可显著提高灵敏度,减少漏诊情况。

Objective To explore the clinical value of high-risk human papilloma virus(HPV)deoxyribonucleic acid(DNA)typing combined with thinprep cytologic test(TCT)and colposcopy in the early screening of cervical precancerous lesions.Methods 100 patients with cervical precancerous lesions and 60 patients with chronic cervicitis who were treated in Huiya Hospital of the First Affiliated Hospital of Sun Yat-Sen University from January 2019 to January 2022 were retrospectively analyzed,and both groups of patients were examined by high-risk HPV-DNA typing,TCT and colposcopy.The pathological examination was used as the gold standard to analyze the diagnostic efficiency of high-risk HPV-DNA typing,TCT and colposcopy and the combination detection,and the differences were compared.Results The sensitivity,specificity and accuracy rate of high-risk HPV-DNA typing+TCT+colposcopy in the diagnosis of cervical precancerous lesions were 98.00%(98/100),38.33%(23/60)and 75.62%(121/160)respectively;The sensitivity of high-risk HPV-DNA typing+TCT+colposcopy were higher than those of high-risk HPV-DNA typing,TCT and colposcopy.The sensitivity of TCT+colposcopy,high risk HPV-DNA typing+colposcopy,high risk HPV-DNA typing+TCT,colposcopy,high risk HPV-DNA typing sensitivity were higher than those of TCT single test;The sensitivity of high risk HPV-DNA typing+colposcopy and high risk HPV-DNA typing+TCT were higher than those of colposcopy,and the differences were statistically significant(P<0.05).The accuracy of high risk HPV-DNA typing+TCT+colposcopy,TCT+colposcopy,high risk HPV-DNA typing+colposcopy,high risk HPV-DNA typing+TCT,colposcopy,high risk HPV-DNA typing were higher than those of TCT single examination,and the differences were statistically significant(P<0.05).There was no statistical significance in the accuracy of other test schemes(P>0.05).There was no statistical significance in the specificity,positive predictive value and negative predictive value among different test schemes(P>0.05).Conclusion In the early screening of cervical precancerous lesions,the combined examination of high-risk HPV-DNA typing,TCT and colposcopy can significantly improve the sensitivity and reduce the missed diagnosis compared with the single examination.