液基细胞学联合人乳头瘤病毒16/18型检测筛查宫颈癌前病变24590例结果分析

Thinprep cytologic test and human papillomavirus type 16/18 test in screening of cervical precancerous lesions in 24590 cases: A result analysis

目的:探讨宫颈液基细胞学(TCT)检测联合高危型人乳头瘤病毒(HPV)16/18型在普查宫颈癌前病变中的可行方法。方法:2014年6月-2017年6月期间对体检的女干部职工24590例行TCT联合HPV16/18型筛查,采取TBS报告方式,对ASCUS以上和(或)HPV16/18阳性患者行宫颈活检。根据3年的筛查数据,回顾性分析宫颈液基细胞学异常和HPV16/18感染情况和病理结果进行比较。结果:24 590例受检查的女干部职工共发现细胞学结果为阴性24 223例,占98.5%(24 223/24 590),HPV16/18阳性351例,占1.43%(351/24 590),细胞学阴性受检者24 223例中,HPV16、18阳性316例,占1.3%(316/24 223);细胞学阳性(ASCUS及以上)367例占1.5%(367/24 590),细胞学阳性患者中ASC-US260例、ASC-H32例,LSIL62例、HSIL13例、SCC0例,分别占1.06%(260/24 590)、0.13%(32/24 590)、0.25%(62/24 590)、0.05%(13/24 590)、0.00%。367例细胞学阳性患者中HPV16/18型阳性35例,阳性率9.54%(35/367);其中ASC-US、ASC-H、LSIL、HSIL,HPV16/18阳性率分别8.08%(21/260)、18.75%(6/32)、9.68%(6/62)、15.38%(2/13);TCT和HPV16/18均阳性35例,其病理结果:SCC 2例,CINⅠ21例,CINⅢI-Ⅲ12例;HPV16、18阴性、LISL及以上67例,其病理结果:慢性宫颈炎42例、CINI19例、CINⅡ-Ⅲ6例;TCT阴性HPV16、18阳性患者316例,其病理结果:慢性宫颈炎233例,CINI68例、CINⅡ-Ⅲ15例。结论:TCT联合HPV16、18检测用于大面积宫颈癌普查,初筛并聚焦管理风险人群,防止单一应用细胞学检查导致漏诊或过度检查,是一种经济合理、有效便捷的宫颈癌筛查方法。

Objective： To investigate the feasible methods of using cervical Thinprep cytologic test（ TCT）and high-risk human papillomavirus（ HPV） type 16/18 test in the screening of cervical precancerous lesions.Methods： A total of 24590 female cadres and staff underwent screening with TCT and HPV type 16/18 test between June 2014 and June 2017,and the TBS report was included.The cervical biopsy was performed in patients with ASCUS and above and/or positive HPV16/18.Based on the 3-year screening data,the abnormal findings of cervical TCT,infection of HPV 16/18,and comparison of pathological findings were retrospectively analyzed.Results： Among 24590 examined female cadres and staff,the TCT findings showed that there were 24223 negative cases,accounting for 98. 5%（ 24223/24590） and 351 positive HPV16/18 cases,accounting for 1. 43%（ 351/24590）. Among 24223 negative TCT subjects,there were 316 positive HPV16/18 cases,accounting for 1. 3%（ 316/24223）.There were 367 positive TCT cases（ with ASCUS and above）,accounting for 1.5%（ 367/24590）.Among positive TCT patients,there were 260 cases of ASC-US,32 of ASC-H32,62 of LSIL,13 of HSIL,0 of SCC,accounting for 1. 06%（ 260/24590）,0. 13%（ 32/24590）,0. 25%（ 62/24590）,0.05%（ 13/24590）,and0.00%,respectively.Among 367 positive TCT patients,35 were positive HPV16/18,with a positive rate of 9.54%（ 35/367）.The positive rates of ASC-US,ASC-H,LSIL,HSIL and HPV16/18 were 8.08%（ 21/260）,18.75%（ 6/32）,9.68%（ 6/62） and 15.38%（ 2/13）,respectively.The pathological findings showed that TCT and HPV16/18 were both positive in 35 cases,including 2 cases of SCC,21 of CINI,and 12 of CINI ~ Ⅲ. There were 67 cases with negative HPV 16/18 and LISL and above.There were 42 cases of chronic cervicitis,19 of CINI and 6 of CINⅡ-Ⅲ.The pathological findings in 316 cases of negative TCT and positive HPV 16/18 showed that there were233 cases of chronic cervicitis,68 of CINI,and 15 of CINⅡ-Ⅲ. Conclusion： Using TCT and HPV16/18 test for widely screening and preliminary screening of cervical cancer is an economical,effective and convenient screening method for cervical cancer.It focuses on managing risk groups and prevents cytology alone-induced misdiagnosis or excessive examination.