薄层细胞学联合人乳头瘤病毒检测在宫颈癌筛查中的效果评价

Effectiveness evaluation of thinprep cytology test combined with human papillomavirus detection in cervical cancer screening

目的评价薄层细胞学检测(TCT)联合人乳头瘤病毒(HPV)分型检测在宫颈癌筛查中的效果。方法对就诊承德医学院附属医院妇科的1 381例患者行TCT和HPV分型检测,对符合条件者行病理检查,以病理结果为金标准比较两种筛查方法的效果。结果 (1)TCT检测结果中不明意义的非典型鳞状上皮(ASCUS)以上阳性检出率为15.06%;低级别鳞状上皮内病变(LSIL)以上阳性检出率为12.31%。HPV阳性检出率为20.93%。(2)以宫颈上皮内瘤变(CIN)1以上宫颈病变(CIN1+)为标准计算TCT和HPV分型检测的敏感度、特异度、阳性预测值、阴性预测值、误诊率、漏诊率、诊断符合率和约登指数分别为77.65%、66.12%、79.04%、64.15%、33.98%、22.35%、73.26%、0.437;71.62%、84.31%、95.21%、40.57%、15.69%、28.38%、73.99%、0.559。(3)两种诊断方法平行试验的联合敏感度为93.18%,特异度为72.63%;序列试验的联合敏感度为54.40%,联合特异度为97.83%。即平行试验联合敏感度最高,序列试验的联合特异度最高。结论 TCT,HPV分型检测均具有较好的筛查效果,二者联合可以提高筛查的敏感度和特异度。

Objective To evaluate the effects of thinprep cytology test（ TCT） and human papillomavirus（ HPV） detection in cervical cancer screening. Methods TCT and HPV detection were performed among 1 381 patients from Department of Gynecology in the hospital,then pathological examination was performed among the patients meeting the criteria,the effects of the two methods were compared taking pathological result as gold standard. Results The detection rate of atypical squamous cell of undetermined significance（ ASCUS） and above lesions by TCT was 15. 06%; the detection rate of low-grade squamous intraepithelial lesion（ LSIL） and above lesions by TCT was 12. 31%.The positive rate of HPV was 20. 93%. Taking cervical intraepithelial neoplasia（ CIN） Ⅰ and above lesions（ CINⅠ＋） as the standards,the sensitivities,specificities,positive predictive values,negative predictive values,misdiagnostic rates,missed diagnostic rates,coincidence rates of diagnosis,and Youden indexes were 77. 65%,66. 12%,79. 04%,64. 15%,33. 98%,22. 35%,73. 26%,0. 437 and71. 62%,84. 31%,95. 21%,40. 57%,15. 69%,28. 38%,73. 99%,0. 559,respectively. The sensitivity and specificity of parallel test of TCT combined with HPV detection were 93. 18% and 72. 63%,respectively; the sensitivity and specificity of sequential test of TCT combined with HPV detection were 54. 40% and 97. 83%,respectively. The sensitivity of parallel test of TCT combined with HPV detection was the highest,while the specificity of sequential test of TCT combined with HPV detection was the highest. Conclusion Both TCT and HPV detection have good effect in cervical cancer screening,TCT combined with HPV detection can increase the sensitivity and specificity.