液基涂片细胞学检查联合高危型HPV检测在宫颈病变诊断中的价值

The value of diagnosing cervical lesions by Thinprep cytologic test(TCT) combined with high-risk type HPV DNA testing

目的探讨液基涂片细胞学(TCT)检查联合高危型人乳头瘤病毒(HPV)检测在宫颈病变诊断中的价值。方法收集500例宫颈脱落细胞标本,采用宫颈细胞学检查、HPV DNA检测或2种方法联合检查后,选择所有的HPV阳性和TCT报告为意义不明确的不典型鳞状细胞(ASC-US)以上者,均通过阴道镜取活检,以组织学诊断为金标准,比较宫颈细胞学检查、HPV DNA检测及以上2种方法联合检查与组织病理学诊断的符合率、灵敏度和特异度。结果 313名TCT报告为ASC-US以上者,与组织病理学诊断的符合率为82.4%。268名检测结果为HPV DNA阳性的女性与组织病理学诊断的符合率为77.2%。2种方法联合检查251名女性,与组织病理学诊断的符合率为92.0%。TCT联合HPV DNA检测与单纯HPV DNA检测比较,差异有统计学意义(P<0.01)。TCT联合HPV DNA检测与单纯TCT比较,差异有统计学意义(P<0.01)。HPV DNA检测诊断宫颈癌的灵敏度为83.8%,特异度为75.9%,TCT检测诊断宫颈癌的灵敏度为93.5%,特异度为75.4%,TCT检查联合HPV DNA检测诊断宫颈癌的灵敏度为96.3%,特异度为87.5%。结论 TCT联合HPV DNA检测在宫颈病变筛查中比单纯TCT或单纯HPV DNA检测更具有实用价值。

Objective To study the value of diagnosing cervical lesions using the methods of thinprep cytologic test（ TCT）combined with high-risk type HPV DNA testing. Methods 500 cases of cervical cytology specimens were detected by DNA HPV test or DNA HPV test or combined with the two methods. All the specimens which were HPV positive or reported by TCT as atypical squamous cells and glandular cells（ ASC-US） were selected for biopsy. Compared the accuracy,sensitivity and specificity of TCT,DNA HPV test or combined with the two methods on the basis of histopathological diagnosis. Results The coincidence of 313 patients reported by TCT as ASC-US with histopathological diagnosis was 82.4%. Comparing the histopathologic diagnosis,the coincidence of268 patients with HPV DNA positive was 77. 2%. Comparing the histopathologic diagnosis,the coincidence of 251 patients with the positive result of TCT combined with HPV DNA testing was 92.0%. To compare single HPV DNA testing with TCT combined with HPV DNA testing,the difference had statistical significance（ P0.01）; To compare single TCT testing with TCT combined with HPV DNA testing,the difference had statistical significance（ P0.01）. The sensitivity and specificity of HPV DNA testing in diagnosing uterine cervix cancer was 83.8% and 75.9% respectively. The sensitivity and specificity of TCT testing in diagnosing uterine cervix cancer was93.5% and 75.4% respectively. The sensitivity and specificity of TCT combined with HPV DNA testing in diagnosing uterine cervix cancer was 96.3% and 87. 5% respectively. Conclusion TCT joint HPV DNA testing in cervical lesions is more useful than single TCT test or single HPV DNA test.