薄层液基细胞学检测及HPV检测对宫颈癌筛查价值的系统评价

System Evaluation of Thin Prep Cytology Test and HPV Testing for Screening Cervical Cancer

目的:系统评价薄层液基细胞学检查(TCT)及人类乳头状病毒(HPV)检查在子宫颈癌筛查中的应用价值。方法:检索收集2000年以来,Cochrane数据库、Pubmed、MEDLINE、Web of science、EMBASE、万方数据库、清华同方数据库、维普数据库中与TCT及HPV检测在宫颈癌筛查(癌前病变及早期宫颈癌)诊断方面的相关文献,参照Cochrane系统评价的方法对资料进行统计分析。结果:共有12篇文献纳入研究,TCT合并的敏感性0.65(95%CI,0.62～0.68),特异性0.93(95%CI,0.92～0.93),阳性预测值8.25(95%CI,5.65～12.04),阴性预测值0.27(95%CI,0.18～0.41),合并SROC曲线下面积AUC=0.889,Q值0.819。HPV合并敏感性0.69(95%CI,0.67～0.71),特异性0.91(95%CI,0.90～0.91),阳性预测值3.93(95%CI,2.99～5.18),阴性预测值0.17(95%CI,0.09～0.31),合并SROC曲线下面积AUC=0.871,Q值0.801。结论:薄层液基细胞学检查在宫颈癌筛查中具有较高的诊断准确度,与HPV联合检测可提高诊断的准确性。

ABSTRACT Objective： To evaluate the value of TCT and HPV test in primary cervical lesion screening. Methods： We had analysis to review the relation between TCT and HPV test in primary cervical lesion screening （precancerous lesions and early cervical cancer） ac- cording to Cochrane system and evaluation was conducted with study-level data from 2000 in the Cochrane database, EMBASE, MED- LINE, Pubmed, Web of science, Tsinghua Tongfang database. Wanfang Database, VIP Database. Results： 12 articles were included. The pooled sensitivity of TCT was 0.65 （95%CI, 0.62-0.68）, specificity was 0.93 （95%CI, 0.92-0.93）, positive predictive value was 8.25 （95%CI,5.65-12.04）, negative predictive value was 0.27 （95%CI,0.18-0.41）, AUC was 0.889, Q was 0.819. The pooled sensitivity of HPV was 0.69 （95%CI, 0.67-0.71）, specificity was 0.91（95%CI, 0.90-0.91）, positive predictive value was 3.93（95%CI, 2.99-5.18）, neg- ative predictive value was 0.17（95%CI, 0.09--4）.31）, AUC was 0.871, Q was 0.801. Conclusion： The thin layer of liquid-based cytology in cervical cancer screening has a high diagnostic accuracy, and can be combined with HPV detection to improve the accuracy of diagnosis.