249例细胞学、HPV-DNA分型检测在宫颈癌初筛中的意义分析

Analysis on significances of cytology and HPV-DNA genotyping in primary screening of 249 cases with cervical cancer

目的:通过对在2010年8月10日～2011年10月1日期间厦门市第二医院有做细胞学、HPV-DNA分型和活检的患者分析了解细胞学、HPV-DNA分型检测在宫颈癌初筛中意义。方法:细胞学筛查:所有进入研究的患者均采用泰普生物科学(中国)有限公司的薄层液基细胞学技术(TCT)产品进行检测。细胞学诊断标准采用TBS分类法。HPV-DNA分型检测:所有进入研究的患者用凯普公司点杂交的采样工具包从宫颈管采集标本,并由主管技师进行点杂交检测操作并做出分析,检测目前已知的21种致癌型HPV DNA(即13种高危HPV及8种低危和中国人常见亚型HPV)。所有进入研究的妇女使用深圳金科威公司的SLC-2000型电子阴道镜,并由专门的妇产科医师进行检查操作,对可疑病灶进行镜下定位活检。结果:细胞学与HPV-DNA分型检测联合筛查总敏感度是91.82%,均高于2种方法单独检测时的敏感度,尤其是CIN2及以上的病变敏感度高达100.00%,因此细胞学与HPV-DNA分型检测联合筛查,是最稳妥的宫颈癌筛查方案,可以把漏诊率降到最低。结论:细胞学目前还是最可靠的宫颈癌初筛方法,HPV-DNA分型检测只能辅助细胞学进行初筛,还不能完全取代它。对于细胞学AS-CUS的处理,HPV-DNA分型检测是最好的一个办法,可以有效地分离出ASCUS中高危人群。细胞学与HPV-DNA分型检测联合筛查与单独做细胞学相比敏感性有所提高,但是筛查成本大大增加,建议在经济较发达的地区使用这一种方法。

Objective： To analyze and understand the significances of cytology and HPV - DNA genotyping in primary screening of cervical cancer by conducting cytology test, HPV -DNA genotyping, and biopsy among patients from the hospital from August 10th, 2010 to October 1 st, 2011. Methods： Cytological screening： all the patients were detected by liquid -based Thin Prep cytology test （TCT） ; the diagnostic criterion of TCT was TBS classification ; HPV - DNA genotyping： cervical canal samples of all the patients were collected by sampling kit of dot blot, supervising technicians conducted dot blot and analyzed the results, 21 kinds of cancer type HPV DNA currently known were detected, including 13 high risk HPV types and 8 low risk and common HPV subtype. All the women underwent electronic colposcopy （SLC -2000, Shenzhen）, the operation was conducted by specialized obstetricians and gynecologists, and suspicious lesions underwent col- poscopic localization and biopsy. Results： The total sensitivity of joint detection of cytological test and HPV - DNA genotyping was 91.82%, which was significantly higher than those of simple cytological test and simple HPV - DNA genotyping, especially for cervical in- traepithelial neoplasia 11 or above lesions, the sensitivity was as high as 100.00%, so joint detection of cytological test and HPV - DNA genotyping was the most reliable method for screening of cervical cancer, which could reduce the missed diagnostic rate to a minimal level. Conclusion ： Cytological test is the most reliable method for primary screening of cervical cancer currently, HPV - DNA genotyping only can assist cytological test for primary screening, but it cant replace cytological test completely. HPV - DNA genotyping is a best method for treat- ment of ASCUS, which can isolate high risk population of ASCUS effectively. Compared with simple cytological test, the sensitivity of joint detection of cytological test and HPV - DNA genotyping increases, but the screening cost increases greatly, it is recommended to use the method in economically developed areas.