318例高级别宫颈上皮内瘤变及宫颈癌患者的TCT和hrHPV检测分析

TCT and hrHPV analysis of 318 cases with high-grade cervical intraepithelial neoplasia and cervical cancer

目的:探讨如何使用现有的筛查方法,减少高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia grade 2 or 3,CIN2/3)及宫颈癌的漏诊。方法:回顾性分析2014年6月至2018年8月318例中国医科大学附属航空总医院治疗的CIN2/3及宫颈癌患者的临床资料,其中CIN2/3为296例、宫颈癌为22例,采用宫颈液基薄层细胞学检查(thinprep cytology test,TCT)及高危型人乳头瘤病毒(high risk human papilloma virus,hrHPV)检测方法,分析患者的年龄、TCT和hrHPV。结果:296例CIN2/3患者中30～39岁患者为130例(43.92%)、占第1位,20～29岁年轻患者为69例(23.31%)、占第3位。318例患者中TCT阳性为199例(62.58%),hrHPV阳性为308例(96.86%),两者联合筛查阳性为313例,阳性率为98.43%(313/318)。hrHPV分型检测主要亚型依次为16、52、58、33、18、31型。结论:CIN2/3及宫颈癌的发病年龄年轻化,年轻患者筛查不容忽视。TCT单独筛查较hrHPV单独筛查易漏诊高级别病变,TCT联合hrHPV筛查可提高检出率。TCT阴性,hrHPV非16、18亚型的其他hrHPV阳性,尤其是hrHPV52、58、33、31亚型阳性患者也建议行阴道镜检查。

Objective:To identify appropriate ways of applying the current cervical screening methods to minimize the occurrence of missed diagnosis of high-grade cervical intraepithelial neoplasia(CIN2/3)and cervical cancer.Methods:A retrospective analysis was conducted based on the clinical data of 318 patients,who had CIN2/3 or cervical cancer and were treated in Aviation General Hospital Affiliated to China Medical University between June 2014 and August 2018.Among these cases,296 involved CIN2/3,and 22 involved cervical cancer.All of the patients involved underwent a thinprep cytology test(TCT)and high-risk human papilloma virus(hrHPV)screening,and their age and TCT and hrHPV results were further analyzed.Results:Among the 296 patients diagnosed with CIN2/3,130 of them(43.92%)were aged between 30 and 39 years,ranking the top among all age groups.Sixty-nine young patients(23.31%)aged between 20 and 29 years were diagnosed with CIN2/3,ranking in the third place.Among all of the 318 cases,the TCT results were positive in 199 cases(62.58%),hrHPV results were positive in 308 cases(96.86%),and there were 313 cases(98.43%,313/318)wherein both TCT and hrHPV results were positive according to joint screening.The most predominant hrHPV subtypes were 16,52,58,33,18,and 31.Conclusions:As an increasing number of young women are diagnosed with CIN2/3 and cervical cancer,their screening should not be ignored.Single use of TCT screening leads to more frequent missed diagnosis of high-grade lesions compared with single use of hrHPV screening,while joint use of both screening methods could improve the detection rate.Even if TCT results were negative,it is suggested to conduct a colposcopy for those patients with high-risk subtypes besides hrHPV16 and 18 positivity,and in particular,for patients with hrHPV 52,58,33,and 31 positivity.