HPV-DNA检测结合液基细胞学检查在宫颈病变筛查中的应用分析

Evaluation of HPV-DNA test and thinprep cytology test in cervical dysplasia screening application

目的探讨HPV-DNA检测结合TCT在宫颈病变筛查中的应用价值。方法分析2231例行TCT和HPV-DNA检查的患者,其中678例行道镜下活组织检查并有病理结果的临床资料。结果 1)2231例TCT中检出阳性率为15.51%,与病理结果比较,TCT中检出LSIL 29例(与病理为CINⅠ的符合率35.80%),HSIL 27例(与CINⅡ和CINⅢ的符合率90.00%),宫颈癌4例(符合率100%)。2)2231例HPV-DNA筛查中,阳性率35.45%,HPV-DNA与病理结果一致率为62.62%,其中TCT结果为ASC-US病例中,HPV-DNA阳性,病理结果阳性者占73.87%;HPV-DNA阴性,病理结果阴性者占83.58%,一致率为77.52%,均具有较高的一致率(P<0.05)。3)TCT用于评价宫颈高度病变的灵敏度、特异度、一致率、阳性预测值、阴性预测值、Kappa值、Youden值分别为:58.92%,71.69%,65.04%,69.33%,61.64%,0.3042,0.3061;HPV-DNA检测分别为:90.65%,41.23%,66.96%,62.62%,80.24%,0.3251,0.3188;TCT联合HPV分别为:96.30%,69.44%,86.53%,84.65%,91.46%,0.6932,0.6574。结论联合采用HPV-DNA及TCT检查能及早发现宫颈癌前病变,提高检出率,降低假阴性。

Objective To evaluate the instructive value of human papillomavirus（HPV-DNA） test and thinprep cytology test（TCT） in diagnosis of cervical lesions.Methods 2231 cases of HPV-DNA,TCT and 678 cases of biopsy under colposcopy were retrospectively analyzed.Results 1）2231 examined women consisted of 346 women diagnosed positive in TCT,detected rate being 15.51%;29 cases were related with LSIL（The coincidence rate 35.80%）,27（90.00%）with HSIL,4 cases（100.0%）with SCC;2） The positive rate of HPV-DNA in the 2231 examined women was 35.45%;the coincidence rates of HPV-DNA with pathologic biopsy were 62.62%,（they were 77.52% when TCT were ASC-US）.Both of them had the high coincidence rates（P0.05）.3） The sensitivity,specificity,efficiency,positive predictive value（PPV）,negative predictive value（NPV）,Kappa values,Youden values of the thinprep cytological test were ：58.92%,71.69%,65.04%,69.33%,61.64%,0.3042,0.3061;The group of HPV-DNA were： 90.65%,41.23%,66.96%,62.62%,80.24%,0.3251,0.3188;The group of HPV-DNA and TCT were ： 96.30%,69.44%,86.53%,84.65%,91.46%,0.6932,0.6574.Conclusions HPV-DNA and TCT test play an important role in early diagnosis of CIN and cervical carcinoma.