意义不明确的不典型鳞状细胞中检测高危型HPV的价值

The value of human papillomavirus testing in atypical squamous cell of undetermined significance

目的探讨在意义不明确的不典型鳞状细胞(ASCUS)中检测HR-HPV,预测宫颈上皮内瘤样病变及浸润癌的诊断价值。方法对宫颈薄层液基细胞学诊断为ASCUS的248例患者分别进行HR-HPV检测、阴道镜下活组织检查。结果在ASCUS患者中,CIN发生率为41.1%(102/248),高级别CIN(CIN2、CIN3)和浸润癌发生率为9.3%(23/248);在HR-HPV阳性组CIN检出率为68.1%(92/135),在HR-HPV阴性组CIN检出率为8.8%(10/113),两组间差异有统计学意义(χ2=89.330,P<0.001)。阳性组发生CIN和浸润癌的风险是阴性组的22.037倍[OR(95%CI)=22.037(10.479～46.342)]。HR-HPV检测CIN和浸润癌的敏感度和特异度分别为68.1%和91.2%;阳性预测值和阴性预测分别为90.1%和70.5%。阴道镜拟诊CIN和浸润癌126例,检出率为80.4%(82/102),其中高级别CIN和浸润癌20例,检出率为87.0%(20/23);阴道镜检测CIN和浸润癌的敏感度和特异度分别为65.1%和83.6%;阳性预测值和阴性预测分别为80.4%和69.9%,与HR-HPV检测功效相似,关联系数为r=0.833;而阴道镜检测高级别CIN和浸润癌的敏感度和特异度分别为80.0%和98.7%;阳性预测值和阴性预测值分别为87.0%和97.8%。结论 HR-HPV阳性的ASCUS患者CIN发生率高,即行阴道镜检查;HR-HPV阴性患者可不行阴道镜检查而不会增加高级别CIN和浸润癌发生风险。

Objective To investigate the significance of high-risk HPV（HR-HPV） testing in atypical squamous cell of undetermined significance（ASCUS）,so as to predict cervical intraepithelial neoplasia （CIN） and invasive cancer.Methods A total of 248 patients with ASCUS tested by thin-prep-1iquid-based cytology were undergone with HR-HPV testing,colposcopy and cervical biopsies. Results Incidence of CIN,high level CIN（CIN2、CIN3） and invasive carcinoma was 41.1% （102/248）and 9.3% （23/248）,respectively. The positive rate of HR-HPV test was 54.4% （135/248）. The frequency of CIN in HR-HPV positive group and negative group was 68.1% （92/135） and 8.8% （10/113）. The difference was statistically significant（χ2=89.330,P0.001）.Incidence of CIN and invasive carcinoma in HR-HPV-positive group was about 22 fold of that in HR-HPV-negative grouyp [OR（95% CI）= 22.037（10.479～46.342 ）].The sensitivity and specificity of HR-HPV test in diagnosing CIN and invasive carcinoma were 68.1% and 91.1%. Positive predictive value and negative predictive value was 90.1% and 70.5%,respectively. There were 126 cases with CIN and invasive cancer diagnosed by colposcopy. The detection rate was 80.4% （82/102）,of which 20 cases of high-level CIN and invasive cancer was diagnosed with detection rate of 87.0%（20/23）. The sensitivity and specificity were 65.1% and 83.6% in diagnosing CIN and invasive carcinoma by colposcopy and the negative predictive value and positive predictive were 80.4% and 69.9%. The sensitivity and specificity of HR-HPV-positive in diagnosing high level CIN （CIN2～ CIN3） and invasive carcinoma by colposcopy were 80.0% and 98.7%,the positive predictive value and negative predictive value was 87.0% and 97.7%.Conclusion Patients with ASCUS and HR-HPV positive have high incidence of CIN that immediate colposcopy was essential for them.