武汉市17万农村妇女宫颈癌筛查方法效果评价

The effect evaluation of three different methods in screening of cervical cancer in 170 thousands of rural women

目的:评价液基薄层细胞技术(TCT)、DNA倍体定量分析和HPV分型检测在宫颈癌和宫颈病变筛查诊断中的应用价值。方法:对武汉市17万农村妇女采用TCT、TBS诊断及DNA倍体定量分析筛查宫颈癌,对细胞学诊断高于低度鳞状上皮内病变或细胞DNA分析有≥3个异倍体细胞,建议做阴道镜下病理组织学活检并进行HPV检测。结果:以组织学诊断CINⅡ及以上级别病变作为评价两种筛查方法的标准,计算出TCT检查和DNA倍体定量分析及HPV检测方法的敏感度和特异度分别为68.35%、52.02%和81.40%、40.12%及92.18%、56.73%;阳性预期值和阴性预期值分别为35.18%、81.19%和35.30%、84.94%及45.47%、94.88%。结论:DNA倍体定量分析敏感度远远高于TCT检查,与TCT联合使用可以大大降低宫颈病变和宫颈癌的漏诊率;HPV检测与细胞学检查结合是宫颈癌最佳筛查方法,可最大限度地降低宫颈癌的漏诊率,提高筛查效率。

Objective： To evaluate the application effect of TCT, quantitative analysis of cervical cellular DNA and HPV genotyping detection in screening of cervical cancer. Methods： More than 170 thousands of rural women accepted the screening of cervical cancer in 2011 through quantitative analysis of cellular DNA and liquid - based cytology. The cases whose results exceeding LSIL in cytological di- agnosis or exceeding 3 heteroploid cells in quantitative analysis of cellular DNA were suggested to make a biopsy of histopathology of cervix and accept a HPV genotyping detection. Results： Defining histological diagnosis of CIN H and CIN [I above as a positive threshold, to cal- culate the sensitivity and specificity of TCT, quantitative analysis of cellular DNA and HPV genotyping detection were 68.35% , 52.02% and 81.40% , 40. 12% and 92. 18% , 56. 73% ; the positive predictive value and negative predictive value were 35. 18% , 81.19% and 35.30%, 84. 94% and 45.47%, 94. 88%. Conclusion： The sensitivity of quantitative analysis of cellular DNA is far higher than TCT, and combined application of these two methods can greatly reduce the missed cases. HPV genotyping detection and cytological test can be used in screening of cervical cancer, can maximally reduce the missed cervical cancer cases, improve the efficiency of screening.