液基细胞学非典型鳞状上皮细胞(ASCUS)联合高危HPV检测筛查宫颈癌的临床应用

Clinical application of liquid-based cytology atypical squamous epithelial cells(ASCUS) combined with highrisk HPV screening for screening cervical cancer

目的通过将液基细胞学检查结果为非典型鳞状上皮细胞(ASCUS)的患者进行高危HPV检测评价筛查宫颈癌前病变及宫颈癌的临床价值。方法将本院就诊或体检的患者作为研究对象,选择同时进行液基细胞学(TCT)和高危HPV(HR-HPV)检测的患者3 106名,选取TCT结果为ASCUS或HR-HPV阳性的患者作为研究对象,所有病例均以阴道镜下组织病理学检查结果为金标准,分别统计TCT检查结果为ASCUS和HR-HPV阴性组[TCT(ASCUS)+HPV(-)]、TCT结果阴性和HR-HPV阳性组[TCT(-)+HPV(+)]、TCT结果为ASCUS和HR-HPV阳性组[TCT(ASCUS+HPV(+))]的组织学符合率。结果 217例ASCUS患者的阴道镜下组织病理学检查结果符合率50.23%,其中炎症占49.77%,低级别鳞状上皮内病变占35.48%,高级别鳞状上皮内病变占12.90%,宫颈癌占1.84%;高危型HPV检测3 106例,阳性者598例,占19.25%;阴性者2 508例,占80.75%;其中[TCT(ASCUS)+HPV(-)]组97例,组织病理学检查结果符合率9.28%,其中炎症占90.72%,低级别鳞状上皮内病变占7.22%,高级别鳞状上皮内病变占2.06%,无宫颈癌发现。[TCT(-)+HPV(+)]组478例,组织病理学检查结果符合率37.24%,其中炎症占62.76%,低级别鳞状上皮内病变占30.96%,高级别鳞状上皮内病变占5.86%,宫颈癌占0.42%。[TCT(ASCUS)+HPV(+)]组120例,组织病理学检查结果符合率83.33%,其中炎症占16.67%,低级别鳞状上皮内病变占58.33%,高级别鳞状上皮内病变占21.67%,宫颈癌占3.33%。结论液基细胞学检查结果为ASCUS患者联合高危HPV检测筛查宫颈癌具有积极的作用,液基细胞学检查结果为ASCUS的患者有一定比例的癌前病变及宫颈癌,对于宫颈癌的早发现和早治疗具有较高的临床价值,值得推广应用。

Objective To evaluate the clinical value of high-risk HPV test in patients with atypical squamous cell(ASCUS)by screening liquidbased cytology for cervical precancerous lesions and cervical cancer.Methods A total of3106patients who were treated with liquid-based cytology(TCT)and high-risk HPV(HR-HPV)were selected as the subjects with ASCUS or HR-HPV positive as the subjects.The results of TCT examination were ASCUS and HR-HPV negative group[TCT(ASCUS)+HPV(-)],TCT negative and HR-HPV were negative in all cases,and all the patients were treated with colposcopic histopathological examination.The TCV(+)+HPV(+)}and the TCT results were the histological compliance rates of ASCUS and HR-HPV positive group[TCT(ASCUS+HPV(+))].Results The coincidence rate of colposcopic pathology was50.23%in217ASCUS patients,among which49.77%were inflammation,35.48%in low grade squamous intraepithelial lesion,12.90%in high grade squamous intraepithelial lesion,1.84%;high-risk HPV detection of3106cases,positive598cases,accounting for19.25%;negative2508cases,accounting for80.75%;which[TCT(ASCUS)+HPV(-)]97cases,histopathological examination results rate of9.28%,of which inflammation accounted for90.72%,low grade squamous intraepithelial lesions accounted for7.22%,high grade squamous intraepithelial lesions accounted for2.06%,no cervical cancer found.[TCT(-)+HPV(+)]group,the histopathological examination results in line with the rate of37.24%,of which62.76%of inflammation,low grade squamous intraepithelial lesions accounted for30.96%,high grade squamous intraepithelial lesions accounted for5.86%,cervical cancer accounted for0.42%.[TCT(ASCUS)+HPV(+)]group,the coincidence rate of histopathological examination was83.33%,of which inflammation accounted for16.67%,low grade squamous intraepithelial lesions accounted for58.33%,high grade squamous intraepithelial lesions accounted for21.67%,cervical cancer accounted for3.33%.Conclusion Liquid-based cytology results in patients with ASCUS combined with highrisk HPV screening screening cervical cancer has a positive effect,liquid-based cytology results for ASCUS patients have a certain proportion of precancerous lesions and cervical cancer,early detection of cervical cancer Early treatment has a high clinical value,it is worth promoting the application.