HPV或TCT检测对农村地区妇女早期宫颈癌筛查价值对比分析

Comparative analysis of HPV or TCT screening value of early cervical cancer among rural women

目的宫颈癌是排名第4的女性常见恶性肿瘤之一,且致病原因明确,可在早期进行预防。本研究以淄博市适龄农村妇女宫颈癌筛查项目为例,比较2种筛查方法在早期宫颈癌筛查中应用效果,旨在探讨合理筛查方案。方法将2014-07-01-2018-12-31参加张店区中埠镇卫生院宫颈癌免费筛查项目的9788名农村妇女作为研究对象,采用液基细胞学检查(thinprep cytologic test,TCT)和人乳头瘤病毒(human papilloma virus,HPV)检测,并联合阴道镜下活检进行宫颈癌筛查,对比2种检查方法对宫颈癌、非典型鳞状上皮细胞(atypical squamous cell of undefined significance,ASCUS)及以上程度宫颈病变阳性预测值。结果TCT初筛阳性者490例,阳性率为5.01%;HPV初筛阳性者465例,阳性率为4.75%,2种方法初筛阳性检出率差异无统计学意义,χ^2=0.688,P=0.249。经阴道镜及多点活检病理组织学检查,TCT初筛阳性者宫颈浸润癌6例,非宫颈癌45例,宫颈癌阳性预测值为0.76%,ASCUS及以上程度宫颈病变的阳性预测值为10.41%;HPV初筛阳性者宫颈浸润癌7例,非宫颈癌51例,宫颈癌阳性预测值为1.51%,ASCUS及以上程度宫颈病变的阳性预测值为12.47%,2种检测方法宫颈癌阳性预测值、ASCUS及以上程度宫颈病变阳性预测值比较,差异均无统计学意义,均P>0.05。结论TCT与HPV检测对适龄农村妇女宫颈癌筛查结果并无差异,可根据具体情况选择运用,但尚需扩大样本验证。

OBJECTIVE Cervical cancer is one of the most common malignant tumors among women in the fourth ranking,and the cause of the disease is clear,and it can be prevented at an early stage.This study takes the cervical cancer screening program for rural women in Zibo City as an example to compare the effects of two screening methods in early cervical cancer screening,in order to explore a reasonable screening program.METHODS A total of 9 788 rural women who participated in the free screening screening program for cervical cancer in Zhongbu Town Health Center of Zhangdian District from July 1,2014 to December 31,2018 were selected as subjects,using thin-precipitated cytologic test(TCT)and human papilloma.The virus human papilloma virus(HPV)was detected and combined with colposcopy biopsy for cervical cancer screening.The positive predictive value of the two methods for cervical cancer,ASCUS and above cervical lesions was compared.RESULTS 490 cases were positive for TCT,the positive rate was 5.01%;465 cases were positive for HPV,the positive rate was 4.75%.There was no significant difference in the positive detection rate between the two methods,χ^2=0.688,P=0.249.According to histopathological examination of colposcopy and multi-point biopsy,6 cases of cervical invasive carcinoma were positive for TCT screening,45 cases were non-cervical cancer,the positive predictive value of cervical cancer was 0.76%,and the positive predictive value of cervical lesions of ASCUS and above was10.41%;HPV primary screening positive for cervical invasive carcinoma in 7 cases,non-cervical cancer in 51 cases,cervical cancer with a positive predictive value of 1.51%,ASCUS and above cervical lesions with a positive predictive value of12.47%.There were no significant differences in the positive predictive value of cervical cancer and the positive predictive value of cervical lesions(all P>0.05).CONCLUSION There was no difference between TCT and HPV in cervical cancer screening among rural women of appropriate age,it can be selected and applied according to specific conditions,but it still needs to be verified by expanded samples.