初善仪和子宫颈液基细胞学及人乳头瘤病毒检测在子宫颈疾病筛查中的应用价值研究

Application Value of TCT,HPV and TruScreen in Screening Cervical Disease

目的:研究子宫颈癌筛查系统初善仪(TS)、子宫颈液基细胞学(TCT)和人乳头瘤病毒(HPV)检测在子宫颈疾病筛查中的应用价值,寻找更为有效的子宫颈癌筛查方案。方法:选取自2018年5月至2019年1月就诊于郑州大学第三附属医院妇科门诊进行子宫颈疾病筛查的已婚女性共315例,分别行TS、HPV和TCT检查,任一结果阳性均行阴道镜下子宫颈组织活检术,以子宫颈组织病理结果作为诊断标准,评价3种筛查方法的灵敏度、特异度、假阴性率、假阳性率和Kappa值。结果:①3种筛查方法单独应用时,与TCT、HPV相比,TS灵敏度、假阴性率差异无统计学意义,但特异度、假阳性率差异有统计学意义(P<0.05);TS的Kappa值最高为0.59(P<0.05)。②HPV+TS与TCT+TS联合筛查的灵敏度、特异度、假阳性率及假阴性率比较差异均无统计学意义(P>0.05);Kappa值分别为0.73、0.57、0.00,TS联合HPV筛查结果与病理结果一致性显著。③HPV阳性患者再行TS检查,筛查特异度较HPV单独筛查时提高至93.33%(P<0.05);TCT阳性患者再行TS检查,TS筛查灵敏度、特异度均有提高,但与TCT单独筛查比较,差异无统计学意义(P>0.05);两种筛查方案的Kappa值分别为0.79、0.51(P<0.05)。结论:3种筛查方法单独应用时TS的特异度及与病理结果一致性均较其他两种方法好。TS联合HPV筛查结果与病理结果一致性显著提高。HPV或TCT检测阳性患者再行TS筛查时均能提高筛查的特异度及病理结果一致性。

Objective:To find a more effective and accuratescreening programfor cervical cancer by using the TruScreen(TS)、Thin-prep cytological test(TCT)and Human papilloma virus(HPV).Methods:The study group included 315 outpatients for cervical disease screening from May 2018 to January 2019 at the third affiliated Hospital of Zhengzhou University.The specimens were evaluated by HPV,TCT and TS.All patients who were positive in any examination have sequentially performed cervical biopsy under colposcopy.The sensitivity,specifsity,false positive rate and kappa value of the three screening methods were evaluated.We analyzed the values of these three screening methods alone or combined by using the chi-square test.Results:①When used alone,there was no difference in sensitivity and false negative rate of TS compared with TCT or HPV,but there was significant difference in specificity and false positive rate.Among the three methods,the Kappa value of TS was the highest(0.59)(P<0.05).②There was no difference in sensitivity,specificity,false positive rate and false negative rate between the combined screening schemes.The Kappa values of three screening shemes were 0.73,0.57 and 0.00,respectively.The Kappa value showed that the results of TS combined with HPV were in good consistency with pathological diagnosis.③The specificity of TS test for HPV positive patients was 93.33%,higher than that for HPV alone.The sensitivity and specificity of TS test for TCT positive patients were improved.The Kappa values of the two screening schemes were 0.79(P<0.05)and 0.51(P<0.05).Conclusions:The programs of HPV or TCT combined with TS could improve the specificity anddecrease the false negative rate.