液基细胞学检查联合人乳头瘤病毒基因分型检测在宫颈癌筛查中的应用

Liquid-based cytology combined HPV-DNA genotyping in cervical cancer screening

目的探讨液基细胞学检查(TCT)联合人乳头瘤病毒基因(HPV-DNA)分型检测在宫颈癌筛查中的应用价值。方法对28 524例女性患者进行TCT检测,其中5 932例TCT诊断为不能明确意义的非典型鳞状细胞(ASCUS)及以上的患者均行HPV-DNA分型检测及宫颈活检,分析TCT和HPV感染与宫颈癌及癌前病变的相关性。结果共检测样本28 524例,其中良性病变22 592例(79.20%),ASCUS 4 824例(16.91%),鳞状上皮内低度病变(LSIL)776例(2.72%),鳞状上皮内高度病变(HSIL)316例(1.11%),鳞状细胞癌(SCC)16例(0.06%)。HSIL符合率为97.47%(308/316例),SCC符合率为100%(16/16例)。HPV-DNA分型检测5 932例,其中阳性1 486例,阳性率为25.05%。TCT诊断与活检结果比较,良性病变与CINⅠ、CINⅡ、CINⅢ比较差异有统计学意义(P<0.01);CINⅠ、CINⅡ、CINⅢ、SCC间比较差异有统计学意义(P<0.01)。宫颈活检结果与HPV感染在炎症及CINⅠ、CINⅡ、CINⅢ、SCC组间比较差异有统计学意义(P<0.01)。结论 TCT与活检,特别是针对高级病变及癌,符合率较高,特异性较强。TCT与HPV-DNA分型检测对诊断宫颈癌及癌前病变具有敏感、特异和早于形态学改变的特点,具有较高的临床应用价值和推广前景。

Objective To investigate the value of the liquid-based cytology（TCT） joint HPV-DNA genotyping in cervical cancer screening.Methods Liquid-based cytology（TCT） combined HPV-DNA genotyping,and TCT were detected in 28 524 women,including 5 932 of TCT cytological diagnosis of ASCUS or more patients underwent genotyping of HPV-DNA detection and cervical biopsy,TCT and HPV infection and cervical cancer and precancerous lesions to cervical biopsy results confirmed standard.Results The total number of samples tested were 28 524 cases.Benign reactive changes were 22 592 cases（79.20%）,ASCUS 4 824 cases（16.91%）,LSIL 776 cases（2.72%）,HSIL 316 cases（1.11%）,and the SCC 16 cases（0.06%）,in which HSIL coincidence rate was 97.47%（308/316 cases）,and the SCC coincidence rate was 100%（16/16 cases）.HPV-DNA genotyping tests were conducted in 5 932 cases,and the positive was 1 486 cases with a positive rate of 25.05%.High-risk 1221 cases（82.17%）,type 16（271/1 221,accounting for 22.19%）.When TCT diagnosis were compared with biopsy results,benign lesions compared with CIN Ⅰ,CIN Ⅱ,CIN Ⅲ,the differences had statistical significance（P0.01）.When cervical biopsy results were compared with HPV infection,inflammation and CIN Ⅰ,CIN Ⅱ,CIN Ⅲ,the SCC groups,the differences were statistically significant（P0.01）.Conclusion TCT check with the pathological diagnosis is effective in detecting advanced lesions and cancer with higher coincidence rate and stronger specificity.TCT and HPV-DNA genotyping is sensitive,specific,and earlier than the morphological changes in the diagnosis of cervical cancer and precancerous lesions.It has high clinical value and promotion prospects.