TCT和HR-HPV-DNA检测在宫颈癌和癌前病变筛查中的临床价值

Determination of the Diagnostic Value of TCT and HR-HPV-DNA Detection in the Screening for Cervical Cancer and Precancerous Lesions

目的在对宫颈癌和癌前病变的临床诊断和筛查实践中,通过回顾性分析比较TCT细胞学及高危HPV基因分型检测的优势,评判其临床应用价值。方法研究了2015年1月至2015年12月期间,在日照市人民医院就诊、有宫颈病变并进行了HR-HPV-DNA、TCT检测的患者共765例,对有1项以上异常并且知情同意的246例患者进行病理组织学检查,其中161例患者检查结果为阳性,并以此为阳性判断标准,比较两种方法学单用与联合应用对宫颈癌和癌前病变检出的灵敏度、特异性、准确度。结果 HR-HPV-DNA检测对宫颈癌和癌前病变筛查灵敏度最高,特异性、准确度低于TCT检测,两者联合检测特异性、准确度高于单独采用TCT细胞学检查或HR-HPV-DNA检测,其中联合检测特异性与单独采用HR-HPV-DNA检测相比差异具有统计学意义(P<0.05)。结论宫颈组织的细胞学和HR-HPV-DNA分型检测是宫颈癌筛查有效的方法,联合采用两种方法检测,更有利于宫颈癌的早期诊断。

Objective To assess the characteristics and explore the clinical application value of TCT, high-risk HPV detection and the combination of these two methods in the diagnosis and screening for cervical cancer and precancerous lesions by a retrospective study. Methods A total of 765 cases that underwent TCT and/or high risk HPV detection on their cervical lesions during the period from January 2015 to December 2015 were recruited in this study. According to the principle of voluntariness and informed consent, 246 cases with at least one positive result were selected and further investigated by biopsy histopathological diagnosis, and the pathological positive results shown in 161 patients were considered as the gold standard. The performance of TCT and high-risk HPV detection and the combination of both techniques were compared and validated by a histological follow-up. Results The sensitivity of the high-risk HPV detection was significantly higher in the screening for cervical cancer and precancerous lesions than the TCT, while its specificity and accuracy was significantly lower than TCT. The specificity and accuracy of high-risk HPV detection combined with TCT were significantly higher than those with TCT or high-risk HPV detection alone. There was statistically significant difference in the specificity and accuracy between the combined detection and the high-risk HPV detection （P〈0.05）. Conclusion Though both TCT and high-risk HPV detection have diagnostic efficacy, the combination of these two techniques show a substantial advantage and should be used as a reliable method in the screening and early diagnosis for cervical cancer and precancerous lesions.