绝经后女性宫颈癌前病变筛查方法的比较

Compassion of Screening Methods for Cervical Precancerous Lesions in Postmenopausal Women

目的:探讨绝经后女性宫颈细胞学与人乳头瘤病毒(HPV)检测在宫颈癌前病变筛查中的作用。方法:回顾性分析2017年10月—2018年9月于天津市第一中心医院妇科门诊因宫颈筛查异常行阴道镜下活检的113例绝经后女性,分析不同宫颈液基薄层细胞学检查(TCT)及高危型HPV(HR-HPV)结果对宫颈病变检出的情况,比较组织学高度鳞状上皮内病变(HSIL)中宫颈TCT和HPV检测的敏感度、特异度、阳性预测值和阴性预测值。结果:绝经后女性HR-HPV感染分布与宫颈病变分布差异无统计学意义(χ2=0.809,P=0.303)。细胞学高风险组中组织学CINⅡ+的检出率高于低风险组(χ2=29.018,P=0.000);宫颈活检组织学病变程度与宫颈细胞学严重程度呈弱正相关(r=0.389,P=0.000)。免疫组织化学(免疫组化)阳性组中宫颈高级别病变分布情况高于阴性组,差异有统计学意义(P=0.000)。绝经后女性宫颈TCT和HR-HPV筛查方法的敏感度、特异度、阳性预测值和阴性预测值分别为78.38%、75.00%、60.42%、87.69%和94.59%、10.13%、33.98%、80.00%。结论:宫颈TCT级别高、免疫组化阳性的绝经后女性有宫颈高级别病变的风险,需引起临床医师的关注。

Objective:To explore the role of cervical cytology and human papillomavirus (HPV) screening of cervical precancerous disease in postmenopausal women. Methods:113 postmenopausal cases who underwent colposcopic biopsy due to screening abnormality were performed in a retrospective analysis from October 2017 to September 2018. The detection of cervical lesions by different TCT and HPV results was analyzed. The sensitivity, specificity, PPV and NPV of TCT and HPV detection in high squamous intraepithelial lesions (HSIL) were compared. Results:There was no significant difference between the distribution of high-risk HPV (HR-HPV) infection and cervical lesions in postmenopausal women ( χ2=0.809, P=0.303). It had statistically significance that those with high-risk in cytology or positive results in immunohistochemistry had severer cervical diseases than the counterparts( χ2=29.018, P=0.000;r=0.389, P=0.000). Sensitivity, specificity, PPV and NPV of TCT and HR-HPV testing in postmenopausal women were separately 78.38%, 75.00%, 60.42%, 87.69% and 94.59%, 10.13%, 33.98%, 80.00%. Conclusions: Postmenopausal women with high TCT level and positive immunohistochemistry have the risk of high-level cervical lesions, which should be paid attention to by clinicians.