电子阴道镜用于HR-HPV阳性患者分流管理的可行性研究

Study on feasibility of electronic colposcope used for shunt management of patients with positive HR-HPV

目的:探讨电子阴道镜用于高危型人乳头瘤病毒(high risk human papillomavirus,HR-HPV)阳性患者分流管理的可行性。方法:对1 984例19～63岁要求防癌筛查的女性,同时给予液基薄层细胞学(TCT)及HR-HPV检测,1周后对细胞学及HR-HPV阳性者给予电子阴道镜检查及活检组织病理学检查。以组织病理学诊断为"金标准",比较液基细胞学及电子阴道镜对HR HPV阳性病例检出高级别CINⅡ及其以上病变(≥CINⅡ,即CINⅡ+)的敏感性及特异性。结果:1 984例中,HR-HPV阳性366例,阳性率18.44%。其中350例同时具有TCT、阴道镜检查结果,阴道镜及TCT同时异常者132例,占49.62%(132/266)。CINⅠ+检出率44.00%(154/350),CINⅡ+及浸润癌检出率34.00%(119/350)。细胞学异常率58.85%(206/350),以≥ASCUS为阳性标准时,其敏感性77.19%,而特异性只有50.00%。以≥LSIL为标准时,CINⅡ+检出敏感性降低(43.86%),特异性则明显提高(82.63%)。阴道镜异常率52.86%(185/350),CINⅡ+检出敏感性、特异性分别为91.23%,65.68%。浸润癌检出率100.00%。以检出CINⅡ+为终点,两组比较具有统计学差异(P<0.05)。结论:电子阴道镜对于HR-HPV阳性者进行分流具有较高的敏感性和阴性预测值。单独采用HR-HPV进行防癌初筛者,HR-HPV阳性首选电子阴道镜检查,可更早发现更多的高级别CIN及癌。

Objective： To explore the feasibility of electronic colposcope used for shunt management of patients with positive high risk human papillomavirus （HR- HPV） . Methods： Thin prep cytological test （TCT） and HR -HPV test were conducted among 1 984 women receiving anti -cancer screening, electronic colposcopy and pathological examination after biopsy were performed among the patients with positive cytological results and HR- HPV. Histopathological diagnosis was designed as gold standard, the sensitivities and specificities of TCT and electronic colposcope for detecting cervical intraePithelial neoplasia （CIN） Ⅱ and above lesions （ CIN Ⅱ ＋ ） among patients with positive HR - HPV were compared. Results： Among 1 984 women, 366 patients were found with positive HR - HPV, the positive rate was 18.44% ; 350 patients received TCT and laparoscopy simultaneously, 132 patients were found with abnormal results of laparoscopy and TCT, accounting for 49. 62% （132/266） . The detection rate of CIN Ⅰ ＋ was 44. 00% （154/350） ; the detection rate of CIN Ⅱ ＋ and cervical invasive carcinoma was 34. 00% （119/350） . The incidence rate of cytological abnormality was 58.85% （206/350） ; when designing ≥ ASCUS as positive criterion, the sensitivity and specificity were 77.19% and 50. 00% , respectively. When designing ≥ LSIL as positive cri- teflon, the sensitivity of detection of CIN Ⅱ ＋ decreased （43.86%）, while the specificity increased significantly （82. 63% ） . The inci- dence of laparoscopic abnormalities was 52. 86% （ 185/350）, the sensitivity and specificity of detection of CIN Ⅱ ＋ were 91.23% and 65.68% , respectively. The detection rate of cervical invasive carcinoma was 100. 00%. Designing detection of CIN Ⅱ ＋ as finishing point, there was statistically significant difference between the two groups （ P 〈 0. 05 ） . Conclusion： Electronic colposcope has relatively high sen- sitivity and negative predictive value for shunting patients with positive HR - HPV. Among the patients adopting simple HR - HPV test for anti - cancer screening, electronic colposcope is the first choice for patients with positive HR - HPV, which can find more high - grade CIN and cervical cancer.