高危型人乳头状瘤病毒检测在非典型鳞状细胞中的临床意义

Clinical significance of HR-HPV detection in atypical squamous cells

目的探讨高危型人乳头状瘤病毒（HR-HPV）DNA检测在液基细胞学诊断为ASC-US和ASC-H的两种非典型鳞状细胞（ASC）中的价值及意义。方法收集细胞学诊断为ASC且有完整的HR-HPVDNA检测结果和组织病理学诊断结果的病例共1817例，并对其临床资料进行分析。结果1691例ASC-US患者的组织病理学诊断结果显示，CIN2-3级占5．2％（88／1691）；浸润性癌占0．1％（2／1691）；126例ASC-H患者的组织病理学诊断结果显示，CIN2-3级占28．6％（36／126）；浸润性癌占3．2％（4／126）。ASC-US及ASC-H病例中HR-HPV检测对于CIN2级及以上病变的灵敏度、特异度、阳性预测值和阴性预测值分别为94．40／0、31．9％、7．2％、99．0％和100％、43．0％、45．0％、100％。结论ASC-US和ASC-H患者具有不同的临床结局。HPV DNA饼悄检测对ASC-US患者的分流管理具有重要临床意义，而ASC-H的患者应均进行阴道镜检测。

Objeelive To explore the value and significance of high-risk human papillomavirus （HR-HPV） detection in atypical squamous cells of undetermined significance （ASC-US） and atypical squamous cells （ASC）, which cannot exclude high-grade squamous intraepithelial lesion （ASC-H）. Methods Total of 1817 cases with cytologic diagnosis as ASC were furtherly investigated by Hybrid Capture II （HC- II） test for high-risk HPV DNA and biopsy histopathological diagnosis. The results of the above were compared, respectively. Results Among 1691 cases with the cytologic diagnosis as ASC-US, the CIN II-III cases accounted 5.2% （88/1691） and invasive cervical carcinoma cases accounted 0.1% （2/1691）. Among the 126 ASC-H cases, the CIN II-III cases accounted 28.6% （36/126） and invasive cervical carcinoma cases accounted 3.2% （4/126）. Sensitivity, specificity, positive predictive value and negative predictive value of CIN2 level and above in cases with ASC-US and ASC-H by HR-HPV detection were 94.4%, 31.9%, 7.2%, 99.0% and 100%, 43.0%, 45.0% and 100%, respectively. Conclusions The clinical outcomes of patients with ASC-US and ASC-H are different It is beneficial for managing the patients of ASC-US based on HPV detection, and colposcopy is proposed for all ASC-H patients.