阴道镜联合HPV检查在宫颈癌及宫颈鳞状上皮内病变的指导意义

The Guiding Significance of Colposcopy Combined with HPV Examination in Cervical Cancer and Cervical Squamous Intraepithelial Lesions

目的探究阴道镜联合人乳头瘤病毒(HPV)检测在宫颈癌及宫颈鳞状上皮内病变的指导意义。方法 162例研究对象来自该区2018年1月—2019年12月"两癌"检查项目中社区卫生服务中心宫颈初筛异常转诊阴道镜的患者。其中有119例患者先行HPV检查后再阴道镜检查,另有43例患者拒绝HPV检查,直接行阴道镜检查。检查结果以宫颈活检的病理诊断为标准,对HPV、阴道镜检查以及两者联合检查的宫颈病变检出情况进行分析。结果 119例患者,HPV阳性68例,阳性率为57.14%;162例患者,宫颈活检98例,检出宫颈低级别病变30例,高级别病变22例,宫颈癌2例。其中接受HPV检查的119例患者,宫颈活检78例,检出低级别病变24例,高级别病变21例,宫颈癌2例,活检阳性率60.26%;拒绝进行HPV检查的43例患者,宫颈活检20例,检出低级别病变6例,高级别病变1例,活检阳性率35.00%,低于接受HPV检查患者(χ^2=12.790,P<0.05);对于病理结果显示的宫颈病变,TCT、HPV及阴道镜联合检查的检出率为90.74%,明显高于阴道镜(48.15%)、HPV (64.81%)、TCT(44.44%)以及TCT+阴道镜的检出率(66.67%)。差异有统计学意义(P<0.05)。结论增加HPV检测,与阴道镜联合检查可以明显提高对宫颈癌及宫颈上皮内病变诊断的准确率和减少漏诊。

Objective To explore the guiding significance of colposcopy combined with human papillomavirus(HPV) detection in cervical cancer and cervical squamous intraepithelial lesions. Methods A total of 162 study subjects came from patients who were referred to colposcopy for abnormal cervical screening from the Community Health Service Center during the "Two Cancers" screening program in the district from January 2018 to December 2019. Among them,119 patients underwent HPV examination before colposcopy, and 43 patients refused HPV examination and went directly to colposcopy. The examination results were based on the pathological diagnosis of cervical biopsy as the standard, and the detection of cervical lesions of HPV, colposcopy and the combined examination of the two are analyzed. Results Of the 119 patients, 68 were HPV positive, with a positive rate of 57.14%. Among 162 patients, 98 were cervical biopsy. 30 low-grade cervical lesions, 22 high-grade lesions, and 2 cervical cancers were detected.Among the 119 patients who underwent HPV examination, 78 were cervical biopsy, 24 were low-grade lesions, 21 were high-grade lesions, and 2 were cervical cancer. The positive rate of biopsy was 60.26%;43 patients who refused to undergo HPV examination received cervical biopsy In 20 cases, 6 cases of low-grade lesions and 1 case of high-grade lesions were detected. The positive rate of biopsy was 35.00%, which was lower than that of patients undergoing HPV examination(χ^2=12.790,P=0.000<0.05). For cervical lesions revealed by pathological results, the detection rate of TCT,HPV and colposcopy combined examination was 90.74%, which was significantly higher than the detection rate of colposcopy(48.15%), HPV(64.81%), TCT(44.44%) and TCT +colposcopy(66.67%). The difference was statistically significant(P <0.05). Conclusion Increasing HPV detection, combined with colposcopy can significantly improve the accuracy of diagnosis of cervical cancer and cervical intraepithelial lesions and reduce missed diagnosis.