TCT与HPV联合检测在宫颈癌筛查中的应用

Application of combined detection of TCT and HPV for cervical cancer screening

目的探讨液基细胞学(liquid based cytology,TCT)[1]联合高危型人乳头瘤病毒测定(high-risk human papilloma virus,HR-HPV)在宫颈癌筛查中的临床价值。方法选择体检或门诊就诊的女性就诊者986例作为研究对象,同时对就诊者进行TCT与HR-HPV检测。TCT结果≥ASCUS为阳性,HR-HPV≥1.0为阳性;对于其中任意一项或两项为阳性者,或者临床高度怀疑病变的患者进行阴道镜活检,以病理检查结果为金标准。结果单独进行TCT检测的敏感性,特异性,阳性预测值,阴性预测值分别为:91.49%,94.39%,59.72%,98.59%;单独进行HC2-HPV检测的敏感性,特异性,阳性预测值,阴性预测值分别为:89.36%,84.42%,36.05%,86.01%;TCT和HR-HPV联合检测的敏感性,特异性,阳性预测值,阴性预测值分别为:97.87%,95.73%,59.10%,98.13%;联合检测的敏感性、特异性明显优于单一方法检测。结论 TCT、HR-HPV联合检测,能最大限度地弥补其单一方法检测的缺点和不足,有效提高癌前病变和宫颈癌筛查的敏感性和准确性,减少漏诊和假阴性。

Objective To discuss the clinical value of the liquid based cytology （TCT） in combination with high-risk human papilloma virus detected （HR-HPV） for cervical cancer screening . Methods 986 women from physical examination or outpatient patient department were selected as the objectives. Using Pathology results as the gold standard and positive were determined with the premise that TCT results was higher than that of ASCUS or HR-HPV acuity ~ 1.0. Meanwhile, the positive or clinical highly suspicious lesions were further analyzed by colposcopy biopsy. Results The single TCT detection for sensitivity, specificity, positive predictive value, negative predictive value were 91.49%, 94. 39%, 59.72%, 98.59% respectively; The single HC2-HPV detection for sensitivity, specificity, positive predictive value, negative predictive value were 89. 36%, 84. 42%, 36. 05%, 86.01% respectively ;The combined detection of TCT and HR-HPV detection for sensitivity, specificity, positive predictive value, negative predictive value were 97. 87%, 95.73%, 59. 10%, 98.13% respectively; Obviously, the sensitivity and specificity of the joint detection is superior to a single method. Conclusions The joint TCT and HR for HPV detection can make up for the shortcomings and the insufficiency of the single methods with the maximum, can effectively improve the sensitivity and accuracy of precancerous lesions and cervical cancer screening, reduce missed diagnosis and false negative result.