宫颈病变筛查方法的比较研究

Comparative study on the screening methods of cervical intraepithelial neoplasm

目的探讨早期宫颈癌及癌前病变的最佳筛查方法。方法通过对280例受检病例进行巴氏、液基细胞学及人乳头瘤病毒(HPV)DNA检测,以组织学为金标准,以灵敏度、特异度、准确性、阳性预测值、阴性预测值、阳性拟然比、阴性拟然比为评价指标,评价3种方法对宫颈癌及癌前病变的筛查价值。结果巴氏细胞学、液基细胞学、第2代杂交俘获试验(HC2)灵敏度分别为72.9%、91.5%、85.9%;特异度分别为82.3%、84.1%、69.1%;准确性分别为80.9%、87.6%、76.8%;阳性预测值为76.1%、84.3%、70.1%;阴性预测值为79.7%、91.4%、85.4%;阳性拟然比为4.12、5.75、2.78;阴性拟然比为0.33、0.10、0.20。结论联合应用液基细胞学和HPV DNA检测是检测宫颈病变的有效筛查方法,细胞学异常或临床怀疑异常,应结合阴道镜做进一步诊断,有利于提高宫颈病变的检出率。

Objective To investigate the most effective screening method of the precancerous lesion and early cervical cancer. Methods The Pap smear cytology, the liquid based cytology and the human papillomavirus （HPV） DNA of 280 cases were tested. The results were evaluated by the colposcopic biopsy which was considered as gold standard and were compared with the index of sensitivity, specificity, accuracy, positive predictive value and negative predictive value. Results The sensitivity of three methods was 72.9% ,91.5% ,85.9% ;The specificity was 82.3% ,84.1% ,69.1% ; The accuracy was 80.9% ,87.6% ,76.8% ;The positive predictive value was 76. 1% ,84.3% ,70.1% ;The negative predictive value was 79.7% ,91.4% ,85.4% ;The positive likelihood ratio was 4.12,5.75,2.78 ,and the negative likelihood ratio was 0. 33,0.10,0. 20 respectively. Conclusions The combined use of liquid based cytology and HPV DNA test is an effective screening method of cervical lesions. If there is cytological or clinical suspected abnormality, the colposcope examination is recommend to make further diagnosis, and this can be contributed to improve the detection rate of cervical lesions.