二代杂交捕获技术联合液基细胞学检测在宫颈高级别上皮内瘤变患者冷刀锥型切除术后随访中的应用价值

Application value of hybrid captureⅡ technique and Thinprep cytologic test in follow-up after cold knife conization in patients with high-grade cervical intraepithelial neoplasia

目的探讨二代杂交捕获技术(HCⅡ)联合液基细胞学检测(TCT)在宫颈高级别上皮内瘤变(CINⅡ~Ⅲ)患者冷刀锥型切除(CKC)术后随访中的临床应用价值。方法选取228例CKC后病理确诊为CINⅡ~Ⅲ的患者,于CKC术后3个月、6个月、9个月、12个月和18个月随访时行HCⅡ和TCT检测,并对检测结果阳性患者进行宫颈组织病理学检查。以病理结果为金标准,分析HCⅡ、TCT单独及联合检测诊断病灶复发的效能。结果 228例患者中,有27例在宫颈锥切术后出现复发。HCⅡ、TCT及两种方法联合诊断CINⅡ~Ⅲ期患者CIN术后病灶复发的敏感性分别为92.6%、70.4%、100.0%,特异性为97.5%、96.5%、96.5%,阳性预测值分别为83.3%、73.1%、79.4%,阴性预测值分别为99.0%、96.0%、100.0%,受试者工作特征曲线下面积分别为0.951、0.853、0.983。联合检测的敏感性、阴性预测值、曲线下面积均高于或大于TCT(均P<0.05),而联合检测与HCⅡ、HCⅡ与TCT之间比较,差异均无统计学意义(均P>0.05)。结论 HCⅡ与TCT联合检测可以提高诊断病灶复发的敏感性和阴性预测值,用于CINⅡ~ⅢCKC术后患者的随访具有更高的诊断效能。

Objective To explore the application value of hybrid captureⅡ technique（ HCⅡ） combined with Thinprep cytologic test（ TCT） in the follow-up after cold knife conization（ CKC） in the patients with high-grade cervical intraepithelial neoplasia（ CINⅡ-Ⅲ）.Methods A total of 228 patients pathologically confirmed as CINⅡ-Ⅲ after CKC were enrolled. At the 3,6,9,12 and 18 months after CKC,HCⅡand TCT were conducted during the follow-up,and a cervical pathohistological examination was performed in patients with positive results. The pathological results were taken as gold standard,then the efficiencies of HCⅡ,TCT,and HCⅡ/TCT co-test for diagnosing the recrudescence of lesions were analyzed. Results Of 228 patients,recrudescence existed in 27 patients after cervical conization. The sensitivities of HCⅡ,TCT,and HCⅡ/TCT co-test for diagnosing the recrudescence of lesions in the patients with CINⅡ-Ⅲ after CKC were 92. 6%,70. 4% and 100. 0% respectively,the specificities were 97. 5%,96. 5% and 96. 5% respectively,the positive predictive values were 83. 3%,73. 1% and 79. 4% respectively,the negative predictive values were 99. 0%,96. 0% and 100. 0% respectively,and the areas under receiver operating characteristic curve were 0. 951,0. 853 and 0. 983 respectively. The sensitivity,negative predictive value and area under the curve of HCⅡ/TCT co-test were higher or larger than those of TCT（ all P〈0. 05）,but no statistically significant differences were found in those indices above between HCⅡ/TCT co-test and HCⅡ,or between HCⅡ and TCT（ all P〉0. 05）. Conclusion The combined detection of HC Ⅱ and TCT can improve the diagnostic sensitivity and negative predictive value for the recrudescence of lesions.It obtains a higher diagnostic efficiency in the follow-up of CIN Ⅱ-Ⅲ after CKC.