宫颈细胞学和高危型人乳头瘤病毒联合检测在宫颈腺癌中的辅助诊断价值

Value of combined detection of cervical cytology and high-risk human papillomavirus in the diagnosis of cervical adenocarcinoma

目的·探讨宫颈细胞学和高危型人乳头瘤病毒(human papillomavirus,HPV)联合检测在宫颈腺癌中的诊断价值。方法·回顾性分析2006年1月—2017年12月上海交通大学医学院附属国际和平妇幼保健院收治的所有病理组织学确诊为宫颈腺癌患者的临床资料,通过比较分析单纯细胞学检查、单纯高危型HPV检测以及细胞学联合高危型HPV检测的诊断价值。结果·2 291例宫颈癌患者中480例为宫颈腺癌患者,最终纳入409例患者进行分析。患者平均年龄为(46.8±11.4)岁,其中35～55岁年龄段患者占比为59.2%。按检测方法将患者分为A组(单纯细胞学检测,n=208)、B组(单纯高危型HPV检测,n=103)和C组(细胞学和高危型HPV联合检测,n=98)。A组细胞学检测阳性例数为142例,阳性检出率为68.3%;B组高危型HPV检测阳性例数为85例,阳性检出率为82.5%;C组联合检测阳性例数为93例,阳性检出率为94.9%。3组之间差异有统计学意义(P=0.000)。在宫颈原位腺癌患者中,A组阳性检出率为70.6%,而B组和C组患者均为100.0%,B组和C组显著优于A组(P=0.000)。在宫颈浸润性腺癌患者中,A组阳性检出率为67.9%,B组为75.8%,C组为91.8%,3组之间差异有统计学意义(P=0.000)。结论·宫颈细胞学联合高危型HPV检测可以显著提高宫颈腺癌的阳性检出率。

Objective · To investigate the diagnostic value of combined detection of cervical cytology and high-risk human papillomavirus （HPV） in cervical adenocarcinoma. Methods · The clinical data of patients diagnosed as cervical adenocarcinoma in the International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine from January 2006 to December 2017 were retrospectively collected and analyzed. A comparison among cytology detection, high-risk HPV test, and combined detection of both methods was performed. Results · A total of 2 291 cases of cervical cancer were collected, of which 480 cases were cervical adenocarcinoma patients. Finally, 409 cases of cervical adenocarcinoma were analyzed. The average age of all included patients was （46.8±11.4） years old. The proportion of the patients aged 35-55 was 59.2%. All the patients were divided into three groups, i.e., group A （cytology detection, n=208）, group B （high-risk HPV test, n=103）, and group C （cytology and high-risk HPV combined test, n=98）. There were 142 （68.3%）, 85 （82.5%）, and 93 （94.9%） positive cases in group A, B, and C, respectively. There was a statistically signifcant difference among the three groups （P=0.000）. In the patients with cervical in situ adenocarcinoma, the positive detection rates in group A, B and C were 70.6%, 100.0% and 100.0%, respectively （P=0.000）. And in the patients with cervical invasive adenocarcinoma, the positive detection rates in group A, B, and C were 67.9%, 75.8% and 91.8%, respectively （P=0.000）. Conclusion · Cervical cytology combined with high-risk HPV detection can signifcantly increase the positive detection rate of cervical adenocarcinoma.