人工智能辅助宫颈细胞学筛查联合HPV分流在宫颈癌人群筛查中的应用分析

Analysis of artificial intelligence-assisted cervical cytology screening combined with HPV detection in cervical cancer screening

目的分析人工智能辅助宫颈细胞学筛查联合人乳头瘤病毒(HPV)分流在农村妇女免费宫颈癌筛查中的可行性及应用价值。方法收集2019年5月—2021年11月徐州市一县区35~64岁女性进行免费宫颈癌筛查的资料,分为人工阅片细胞学筛查组(人工阅片组)、人工智能辅助宫颈细胞学筛查组(AI组)、人工智能辅助宫颈细胞学筛查HPV分流组(AI+HPV组),比较2种细胞学筛查结果的阳性检出率(≥ASCUS),比较3组筛查方法病理阳性检出率,观察细胞学结果与病理诊断符合率。结果采用人工智能辅助细胞学筛查的异常细胞学结果检出率明显高于人工阅片组(P<0.001);AI组和AI+HPV组的阴道镜活检病理阳性检出率均高于人工阅片组(P<0.001);其中以病理结果≥HSIL为标准计算阳性病变,AI+HPV组的ASCUS病理阳性符合率最高,与其他2组相比差异亦有统计学意义(P<0.001);以病理结果≥LSIL为标准计算阳性病变,AI组和AI+HPV组的ASCUS病理阳性符合率均高于人工阅片组(P<0.001)。结论人工智能辅助宫颈细胞学筛查技术能够提高细胞学筛查的异常检出率及宫颈癌前病变的检出率,人工智能辅助细胞学联合高危型HPV分流降低了阴道镜转诊率,提高了细胞学与活检病理的诊断符合率。

Objective To evaluate the feasibility and application of artificial intelligence(AI) assisted cervical cytology screening combined with HPV detection in HPV detection for women in the rural areas.Methods Data were collected from free cervical cancer screening for women aged 35-64 in one county of Xuzhou from May 2019 to November 2021.According to different detection methods,the patients were divided into three groups:an artificially reading cytology screening(artificial) group,an artificial intelligence-assisted cervical cytology screening(AI) group,and an artificial intelligence-assisted cervical cytology combined with HPV screening(AI+HPV) group.The positive rates of abnormal cytology screening results(≥ASCUS) were compared between the two cytology screening methods.The positive rates of histopathological examination were compared among all three groups.The consistence between cytological results and pathological diagnosis were also analyzed.Results The AI group presented a higher rate of abnormal cytology screening than the artificial group(P<0.001).The AI group and the AI+HPV group showed a higher rate of pathological diagnosis than the artificial group(P<0.001).When ≥HSIL was used to calculate positive pathology,the positive rate of ASCUS in the AI+HPV group was higher than those in the other two groups(P<0.001).When ≥ LSIL was used to calculate positive pathology,the positive rates of ASCUS in the AI group and the AI+HPV group were higher than that in the artificial group(P<0.001).Conclusions AI-assisted cervical cytology screening can improve the detection rate of abnormal cytology and cervical precancerous lesions.AI-assisted cervical cytology combined with high-risk HPV screening reduces the referral rate of colposcopy and improves the consistence between cytological results and biopsy pathological diagnosis.