TCT、HPV-PCR和阴道镜在宫颈癌疾病诊断中的应用研究

The application research of TCT,HPV-PCR and vaginoscope in the diagnosis of cervical cancer

目的探讨TCT、阴道镜下宫颈组织活检和HPV-PCR3种检测方法在宫颈疾病筛查中的应用价值,指导临床正确应用。方法 1.对细胞学检查为炎症反应性改变的112例和为非典型性增生以上病变的184例病人行阴道镜下宫颈组织学活检。2.另根据TCT和组织学结果对209例病人行HPV-PCR检测。3.对53例第一次宫颈组织活检为阴性结果的病例进行跟踪,并进行第二次组织活检以确定第一次活检的漏诊率。结果 1.以宫颈组织学活检为标准,TCT与组织学结果在炎症反应性改变、意义不明确的非典型性鳞状上皮细胞、不除外高度鳞状上皮内病变的不典型鳞状上皮细胞、低度鳞状上皮内病变、高度鳞状上皮内病变和鳞癌中的阳性符合率分别为92.8%、12.7%、27.8%、68%、100%、100%。细胞学诊断级别越高,阳性符合率越高。2.HPV-DNA检测中,总阳性率为22.5%,其中炎症反应性改变、ASCUS(含ASCUS-H)、CIN Ⅰ、CIN Ⅱ-Ⅲ、SCC的阳性率分别为12.2%、12.3%、43.4%、100%、100%。高危型16/18亚型的感染在宫颈癌及癌前病变的发生上起着重要作用。3.第一次活检的漏诊率为5.9%,漏诊主要发生在细胞学诊断级别低的病例。结论无论是TCT检查、HPV-PCR检查或阴道镜下宫颈组织活检都各有优缺点。因此在临床工作中,应结合病人的病情及经济能力,合理有效选择筛选方法,以降低漏诊率和过度诊断率。

Objective To determine the value of TCT, biopsy of cervix under vaginoscope and PCR detection of HPV in the screening of the cervix disease for clinical practice. Methods 112 patients with inflammation and 184 patients with ASCUS or above were enrolled and detected with biopsy of cervix under vaginoscope. Among them, 209 patients were detected with HPV-PCR based on the results of TCT and histology. And 53 cases with negative results of the first biopsy of cervix were tracked on, and then the second biopsy of cervix was carried on to confirm the rate of missed diagnosis of the first biopsy. Results By the standard of biopsy of cervix, the positive coincidence rates between TCT and histology in inflammation response change, ASCUS, ASCUS-H, LSIL, HSIL and SCC were 92.8%, 12.7%, 27.8%, 68%, 100% and 100% respectively. The higher the rank of cytology diagnosis is, the higher the positive coincidence rate is. The total positive rate of HPV-DNA detection was 22.5%, and the positive rates of inflammation response change, ASCUS（including ASCUS-H）, CINI, CINⅡ-Ⅲ and SCC were 12.2%, 12.3%, 43.4%, 100% and 100% respectively. The infection of high-risk 16/18 hypotype of HPV played the influential role in the occurrence of cervical cancer and precancer. The rate of missed diagnosis at the first biopsy was 5.9%, which mainly occured in the cases whose cytological diagnosis rank was low. Conclusion TCT, HPV-PCR and biopsy of cervix under vaginoscope all had their own merits and shortcomings. So in clinical practice the patients＇ condition and economic capacity should be referenced, and the screening methods also should be selected effectively to decrease the rate of missed diagnosis and excessive diagnosis.