三种宫颈癌筛查方法的临床效果比较及筛查阳性者认知状况调查

Comparison of Clinical Effects of Three Screening Methods for Cervical Cancer and Investigation of Cognitive Status of Positive Screening Patients

目的:研究三种宫颈癌筛查方法的临床效果比较及筛查阳性者认知状况。方法:选取2018年3月~2019年12月有阴道镜检查指征并完成阴道镜检查和宫颈活检的287例患者作为研究对象。对所有研究对象在阴道镜检查前均开展宫颈液基细胞学(TCT)检查、人乳头瘤病毒-脱氧核糖核酸(HPV-DNA)检查以及细胞DNA定量检查。以活检后病理检查结果为金标准,分析上述三种宫颈癌筛查方式的灵敏度、特异度以及准确度。此外,采用自拟的调查问卷的方式明确宫颈癌筛查阳性患者的认知状况。结果:以病理学结果为金标准,宫颈上皮内瘤变2(CIN2)及以上为阳性,TCT检查宫颈癌前病变的灵敏度、特异度以及准确度分别为68.63%(35/51)、78.81%(186/236)、77.00%(221/287)。HPV-DNA检查宫颈癌前病变的灵敏度、特异度以及准确度分别为94.12%(48/51)、59.32%(140/236)、65.51%(188/287)。细胞DNA定量检查宫颈癌前病变的灵敏度、特异度以及准确度分别为72.55(37/51)、86.86%(205/236)、84.32%(242/287)。HPV-DNA检查的灵敏度高于TCT检查和细胞DNA定量检查(P<0.05),细胞DNA定量检查的特异度及准确度均较TCT检查和HPV-DNA检查更高(P<0.05)。了解宫颈癌筛查的人数占比为92.16%,了解定期筛查宫颈癌的重要性人数占比17.65%,了解宫颈癌筛查方式人数占比为9.80%,了解HPV相关知识人数占比0.00%,了解宫颈癌筛查可早期检出病变人数占比为15.69%。结论:HPV-DNA检查应用于宫颈癌筛查中具有较高的灵敏度,而细胞DNA定量检查具有较高的特异度以及准确度,筛查阳性者的认知状况有待提高。

Objective:To study the clinical effect comparison of of three screening methods for cervical cancer and the cognitive status of positive screening patients.Methods:A total of 287 patients with indications for colposcopy and completed colposcopy and cervical biopsy from March 2018 to December 2019 were selected as the study subjects.Cervical thinprep cytologic test(TCT)examination,human papillomavirus-deoxyribonucleic acid(HPV-DNA)examination and quantitative cell DNA examination were performed for all subjects before colposcopy.Taking the pathological examination results after biopsy as the gold standard,the sensitivity,specificity and accuracy of the above three cervical cancer screening methods were.In addition,a self-designed questionnaire was used to determine the cognitive status of positive cervical cancer screening patients.Results:Using the pathological results as the gold standard,cervical intraepithelial neoplasia 2(CIN2)and above were positive,the sensitivity,specificity and accuracy of TCT examination were 68.63%(35/51),78.81%(186/236)and 77.00%(221/287),respectively.The sensitivity,specificity and accuracy of HPV-DNA examination in cervical precancerous lesions were 94.12%(48/51),59.32%(140/236)and 65.51%(188/287),respectively.The sensitivity,specificity and accuracy of quantitative detection of cervical precancerous lesions by quantitative cell DNA examination were 72.55(37/51),86.86%(205/236)and 84.32%(242/287),respectively.The sensitivity of HPV-DNA examination was higher than that of TCT examination and quantitative cell DNA examination(P<0.05),and the specificity and accuracy of quantitative cell DNA examination were higher than that of TCT examination and HPV-DNA examination(P<0.05).The number of people who understanding cervical cancer screening accounted for 92.16%,the number of people who understanding the importance of regular cervical cancer screening accounted for 17.65%,the number of people who understanding cervical cancer screening methods accounted for 9.80%,the number of people who understanding HPV related knowledge accounted for 0.00%,and the number of people who understanding cervical cancer screening could detect lesions early accounted for 15.69%.Conclusion:The application of HPV-DNA examination in cervical cancer screening has a high sensitivity,while the quantitative cell DNA examination has a high specificity and accuracy,and the cognitive status of screening positive patients needs to be improved.