宫颈薄层液基细胞学联合高危型人乳头瘤病毒检测对老年宫颈癌前病变及宫颈癌的诊断价值分析

Analysis of the diagnostic value of cervical thin-layer liquid-based cytology combined with high-risk human papillomavirus detection in the diagnosis of cervical precancerous lesions and cervical cancer in the elderly

目的探讨宫颈薄层液基细胞学(TCT)联合高危型人乳头瘤病毒(HPV)检测对老年宫颈癌前病变及宫颈癌的诊断价值。方法选择2018年1月-2019年12月于金山医院宫颈门诊符合条件的老年患者252例进行研究。所有患者均进行TCT、HPV-DNA检查和阴道镜下活检组织病理学检查。以病理检测结果为金标准,对比分析TCT和HPV-DNA检查在宫颈癌前病变和宫颈癌诊断中的价值。结果不同TCT结果的患者宫颈病变级别差异有统计学意义(χ^2=86.987,P=0.001)。不同HPV-DNA结果的患者宫颈病变级别差异有统计学意义(χ^2=31.559,P=0.001)。252例患者中,TCT(+)+HPV-DNA(+)患者113例,TCT(-)+HPV-DNA(-)46例,TCT(+)+HPV-DNA(+)组与TCT(-)+HPV-DNA(-)组患者宫颈病变级别差异有统计学意义(χ~2=38.580,P=0.001)。TCT和HPV-DNA诊断宫颈病变具有较高的灵敏度(95.65%和92.75%)、较高的阴性预测值(96.94%和94.25%),较低的漏诊率(4.35%和7.24%);TCT和HPVDNA联合检测灵敏度和阴性预测值均达100.00%,漏诊率为0;TCT和HPV-DNA联合检测可提高TCT诊断宫颈癌的灵敏度(85.71%),降低其漏诊率(14.29%),提高HPV-DNA诊断宫颈癌的特异度(53.10%),降低其误诊率(43.67%)。结论TCT和HPV-DNA诊断宫颈病变和宫颈癌各有不足之处,两者联合检测可弥补单独检测的不足,提高诊断效能。

Objective To explore the value of cervical thin-layer liquid-based cytology(TCT) combined with high-risk human papillomavirus(HPV) detection in the diagnosis of cervical precancerous lesions and cervical cancer in the elderly.Methods 252 elderly patients from cervical outpatient department of our hospital from January 2018 to December 2019 were selected.TCT,HPV-DNA and colposcopy biopsy were performed in all patients.The results of pathological examination were used as the gold standard,and the results of TCT and HPV examinations in the diagnosis of cervical precancerous lesions and cervical cancer were analyzed.Results The difference of cervical lesions in patients with different TCT results was statistically significant(χ^2=86.987,P=0.001);the difference of cervical lesions in patients with different HPV results was statistically significant(χ^2=31.559,P=0.001).Among 252 patients,113 cases were TCT(+) and HPV(+),46 cases were TCT(-) and HPV(-).There was significant difference in cervical lesions between TCT(+)+HPV(+) group and TCT(-)+HPV(-)group(χ^2=38.580,P=0.001).TCT and HPV-DNA diagnosis of cervical lesions have high sensitivity(95.65% and 92.75%),high negative predictive value(96.94% and 94.25%),and low missed diagnosis rate(4.35% and 7.24%).The sensitivity and negative predictive value of TCT and HPV-DNA combined detection reached 100.00%,and the missed diagnosis rate was 0.The combined detection of TCT and HPV-DNA can increase the sensitivity of TCT in diagnosing cervical cancer(85.71%),reduce its missed diagnosis rate(14.29%);increase the specificity of HPV-DNA diagnosis of cervical cancer(53.10%),and reduce its misdiagnosis rate(43.67%).Conclusion TCT and HPV-DNA have different deficiencies in the diagnosis of cervical lesions.The combined detection of TCT and HPV-DNA can make up for the deficiencies of single detection and improve the diagnostic efficiency.