不同筛查方法对宫颈高级别鳞状上皮内病变及以上的检出情况

Detection of high-grade squamous intraepithelial lesions or worse by different screening methods

目的探讨宫颈液基细胞学、高危型人类乳头瘤病毒(HPV)及联合检测对宫颈高级别鳞状上皮内病变及以上的检出情况。方法选择2019年6-9月首都医科大学附属北京妇产医院妇科门诊手术室行阴道镜检查的病例1721例,对其宫颈液基细胞学、HPV及宫颈活检病理结果进行回顾性分析及统计。结果1721例中,年龄19~78岁,平均(41.04±10.84)岁。液基细胞学检测结果为不明意义的非典型鳞状细胞(ASC-US)、低级别鳞状上皮内病变(LSIL)、不能除外高度病变的非典型鳞状细胞(ASC-H)、高级别鳞状上皮内病变(HSIL)及非典型腺细胞(AGC)中病理检测为HSIL及以上的检出率分别为22.6%、25.0%、77.3%、90.9%和60.0%,均高于液基细胞学检测结果为无上皮内病变或恶性病变(NILM)的检出率(14.2%),差异均有统计学意义(P<0.05)。高危型HPV检测结果中,HPV16/18阳性和其他HR-HPV阳性中HSIL及以上检出率分别为22.8%和19.0%,均明显高于HPV阴性中的7.3%,差异均有统计学意义(P<0.05)。联合检测阳性656例中,HSIL及以上的检出率为31.3%(205例),明显高于联合检测非阳性组(1065例)的13.7%(146例),差异有统计学意义(χ^(2)=76.93,P<0.001)。结论液基细胞学和高危型HPV检测是宫颈高级别鳞状上皮内病变及以上筛查的重要手段,应重视联合检测阳性的患者,提高检出率。

Objective To explore the detection of high-grade squamous intraepithelial lesion or worse by thinprep cytologic test(TCT),high-risk human papillomavirus(HPV)detection and combined screening methods.Methods A total of 1721 women referred for colposcopy at gynecology clinic of Beijing Obstetrics and Gynecology Hospital from June to November of 2019 were included,and the results of TCT screening,HPV detection and cervical biopsy pathology were retrospectively analyzed.Results In the 1721 cases,the average age was 41.04±10.84 ranged from 19 to 78 years old.The detection rates of high-grade squamous intraepithelial lesions(HSIL)or worse by biopsy in AUSCUS,LSIL,ASC-H,HSIL and AGC groups were 22.6%,25.0%,77.3%,90.9%and 60.0%respectively,which were significantly higher than that in NILM group(14.2%,P<0.05).The detection rates of HSIL or worse by biopsy in HPV 16/18 positive and other HR-HPV positive groups were 22.8%and 19.0%,which were significantly higher than that in the HPV negative group(7.3%,P<0.05).The detection rate of HSIL or worse in the positive group by TCT and HPV detection was 31.3%(205/656),which was significantly higher than that in the control group(13.7%,146/1065;P<0.001).Conclusions TCT and high-risk HPV detection are important methods of screening HSILor worse.The patients with TCT ASC-US or worse combined with high-risk HPV should be paid more attention to improve the detection rate.