人乳头状瘤病毒检测对意义不明确的宫颈非典型鳞状细胞患者分流的探讨

Evaluation of hr-HPV test in the management of atypical squamous cells of undetermined significance

目的探讨高危型人乳头状瘤病毒(hr-HPV DNA)检测对意义不明确的宫颈非典型鳞状细胞(ASC-US)患者临床处理的指导意义。方法经宫颈液基薄层细胞学检查(TCT)诊断为ASC-US的197例患者分别行hr-HPV DNA检测及阴道镜下活检,分析hr-HPV感染阳性组与阴性组中鳞状上皮病变有无差异,hr-HPV DNA检测对鳞状上皮病变的预测价值。结果 hr-HPV DNA检测对ASC-US中鳞状上皮病变发现的敏感度,特异度,阳性预测值,阴性预测值分别为86.4%,75.2%,50.0%,95.1%。阳性组与阴性组中鳞状上皮病变的发生率为50.0%和5.0%,差异有统计学意义(P<0.05)。结论hr-HPV DNA检测对ASC-US病例的进一步处理有指导分流作用,hr-HPV DNA阳性组可进一步行阴道镜下活检,hr-HPV DNA阴性组可于一段时间后复查宫颈细胞学。

Objective To evaluate the use of the high-risk human papillomavirus （hr-HPV） DNA test in the further clinical management of women with atypical squamous cells of undetermined significance （ASC-US）. Methods 197 women diagnosed as ASC-US by liquid-based thinprep cytology test （TCT） underwent the hr-HPV DNA test （the hybrid capture 2, HCⅡ） and colposcopic-directed cervical biopsy respectively. Analyzed difference of squamous intraepithelial lesion （SIL） and squamous cell carcinoma （SCC） between the hr-HPV positive group and the hr-HPV negative group. Assessed predictive value of screening cervical SIL or SCC by the hr-HPV DNA test. Results The ratio of SIL and SCC in the hr-HPV positive group was 50%and obviously higher than that of hr-HPV negative group （P〈0.05）. In detecting SIL and SCC by hr-HPV DNA test, the sensitivity, specificity, positive predictive value and negative predictive value were 86.4%, 75.2%, 50.0%, 95.1%. Con-clusion The hr-HPV test plays an important role in triaging ASC-US. Colposcopic-directed biopsy is the next step to evaluate cervix with positive hr-HPV test. Repeating TCT is adopted for cervix with negative hr-HPV test.