TCT、HPV检测在宫颈锥切术后复发中的预测价值

Predictive Value of Thinprep Cytologic Test and HPV Test for the Recurrence after Conization of Cervical Intraepithelial Neoplasia

目的:评估薄层液基细胞学检查(thinprep cytologic test,TCT)和人乳头瘤病毒(human papillomavirus,HPV)检测在宫颈锥切术后复发中的预测价值。方法:随访531例病理诊断为子宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅱ-Ⅲ级接受宫颈锥切术的患者,分别于术后3、6个月及术后每6-12月随访1次,以TCT及HPV检测作为随访的检测指标,若二者有一项异常,行阴道镜下活组织检查,病理证实存在子颈上皮内瘤变Ⅰ-Ⅲ级者视为复发。采用敏感度、特异度、阳性预测值、阴性预测值表示TCT、HPV检测性能。结果:531例患者中10%(54例)的患者出现不同级别的病变复发。TCT在术后预测病变复发的灵敏度77%,特异度72%;HPV在术后预测病变复发的灵敏度95%,特异度60%,TCT联合HPV预测病变复发的灵敏度100%,特异性80%。术后HPV负荷量>100 RLU/PC者较HPV负荷量<100 RLU/PC者而言术后病变复发的风险增高,差别有统计学意义(P<0.01),术后HPV负荷量>100 RLU/PC是锥切术后病变复发的高危因素。结论:使用细胞学联合HPV检测是有效的预测宫颈锥切术后病变复发的方法,术后高HPV负荷量与病变复发相关,并可对术后复发高风险人群进行分流,临床需严密随访。

Objective： To assess the role of thinprep cytologic test（TCT） and human papillomavirus（HPV） test for the recurrent after conization of cervical intraepithelial neoplasia. Methods： 531 cases of women with cervical intraepithelial neoplasia（CIN） II-III on biopsy were enrolled in this study. All women were treated with conization, the patients were followed up at 3,6 months and 6-12 months after the conization. During these TCT and HPV test were used, if one of TCT and HPV test was positive, biopsy of the colposcope were performed. Recurrence definition： the pathological diagnosis of CIN within 6 moths after conization is the definition of recurrence. In this paper, the sensitivity, specificity, positive predictive value（PPV） and negative predictive value（NPV） are used to indicate the performance of TCT and HPV test. Results： Among 531 cases of follow-up patients, 10 % patients developed recurrence during follow-up.TCT had a sensitivity of 77 % and specificity of 72 % in predicting the recurrent of disease; whereas HPV test had a sensitivity of 95 %and specificity of 60 %, respectively. Furthermore, TCT combined HPV test had a sensitivity of 100 % and specificity of 80 % in the prediction of recurrent disease. In addition, the risk of recurrence was extremely higher in patients with HPV load100 RLU/PC than in those with HPV load 100 RLU/PC. There were statistically significant differences between the patients with the higher HPV load and those with the lower HPV load（P〈0.01）. HPV load was a risk factor for recurrent disease after conization especially when HPV load100 RLU/RC. Conclusions： TCT combined with HPV test was an effective way to predict the recurrent of disease after conization.High HPV load was an important risk factor for the recurrence of disease and should be closely follow-up in the clinic.