p16/Ki-67细胞学双染检测在宫颈癌筛查中的应用价值

Application value of p16/Ki-67 double staining in cervical cancer screening.

目的探究p16/Ki-67细胞学双染检测在宫颈癌筛查中的应用价值。方法选择2019年1~12月在深圳市南山区妇幼保健院进行宫颈癌筛查的400例社区妇女作为研究对象。所有受检者均顺利完成高危型HPV(HR-HPV)筛查、液基细胞学(TCT)检测和p16/Ki-67双染色检测。以组织病理学结果为金标准,比较p16/Ki-67双染色检测与HR-HPV筛查、TCT检测检出CIN2及以上病变(CIN2+)的诊断效能,同时比较p16/Ki-67双染色、HR-HPV筛查在检出意义不明确的不典型鳞状上皮细胞(ASC-US)和低级别宫颈鳞状上皮内病变(LSIL)上的诊断效能。结果p16/Ki-67双染色检出CIN2+病变上的敏感度、阴性预测值分别为91.00%、93.53%,明显高于TCT检测的70.00%、82.76%,特异度、阳性预测值及阴性预测值分别为43.33%、34.87%和93.53%,明显高于HR-HPV筛查的7.00%、25.60%、84.00%,差异均有统计学意义(P<0.05);p16/Ki-67双染色检出ASC-US、LSIL的敏感度分别为59.62%、48.39%,明显高于HR-HPV筛查的11.54%、10.75%,检出ASC-US的特异度为66.09%,明显低于HR-HPV筛查的93.97%,差异均有统计学意义(P<0.05);p16/Ki-67双染色检出HR-HPV阳性患者中CIN2+患者的敏感度、阴性预测值分别为91.67%、93.75%,明显高于TCT检测的69.79%、82.74%和HPV16/18检测的48.96%、79.50%,特异度为42.86%,明显低于HPV16/18检测的67.86%,差异均有统计学意义(P<0.05)。结论p16/Ki-67的表达随着宫颈病变程度的加重呈上升趋势,p16/Ki-67细胞学双染检测在宫颈高级别上皮内病变上检出率较高,能够较为准确地对ASC-US、LSIL患者进行分流,从而有效避免过度诊断和治疗的发生。

Objective To research the value of p16/Ki-67 double staining in cervical cancer screening.Methods A total of 400 cases of cervical cancer screening in Shenzhen Nanshan Maternal and Child Health Hospital from January 2019 to December 2019 were selected as the research objects.All patients successfully completed high-risk HPV(HR-HPV)screening,thinprep cytologic test(TCT)detection,and p16/Ki-67 double staining test.Taking histopathological results as the gold standard,the diagnostic efficacy of p16/Ki-67 double staining,HR-HPV screening and TCT detection in detecting CIN2+and above lesions(CIN2+)were compared.At the same time,the diagnostic efficacy of p16/Ki-67 double staining and HR-HPV screening in the detection of atypical squamous cells(ASC-US)and low-grade cervical intraepithelial lesions(LSIL)were compared.Results The sensitivity and negative predictive value of p16/Ki-67 double staining in detecting CIN2+lesions were 91.00%and 93.53%,which were significantly higher than 70.00%,82.76%of TCT detection;the specificity,positive predictive value,and negative predictive value of p16/Ki-67 double staining were 43.33%,34.87%,and 93.53%,which were significantly higher than 7.00%,25.60%,84.00%of HR-HPV screening(P<0.05);the sensitivity of p16/Ki-67 double staining in the detection of ASC-US and LSIL were 59.62%and 48.39%,which were significantly higher than 11.54%,10.75%of HR-HPV screening;the specificity of p16/Ki-67 double staining in detecting ASC-US was 66.09%,which was significantly lower than 93.97%in HR-HPV screening(P<0.05);the sensitivity and negative predictive value of p16/Ki-67 double staining in detecting HR-HPV positive patients were 91.67%and 93.75%,respectively,which were significantly higher than 69.79%,82.74%of TCT and 48.96%,79.50%of HPV16/18,and the specificity(42.86%)was significantly lower than that of HPV16/18(67.86%),with statistically significant differences(P<0.05).Conclusion The expression of p16/Ki-67 increased with the aggravation of cervical lesions,and the detection rate of p16/Ki-67 double staining in cervical high-grade intraepithelial lesions was higher,which could more accurately shunt ASC-US and LSIL patients,so as to effectively avoid the occurrence of over diagnosis and treatment.