液基薄层细胞学检测、人乳头瘤病毒检测及阴道镜检查在宫颈癌前病变及宫颈癌筛查中的应用价值

The value of liquid-based thin-layer cytology,human papillomavirus testing and colposcopy in the screening of cervical precancer and cervical cancer

目的分析液基薄层细胞学检测(TCT)、人乳头瘤病毒(HPV)及阴道镜检查在宫颈癌前病变(CIN)、宫颈癌(CC)筛查中的应用价值。方法选取2020年1月至2022年4月上饶市人民医院接收的139例疑似CIN患者为研究对象,入院时均进行TCT、HPV检测及阴道镜检查,并经病理学检查确诊,将此结果作为诊断依据,比较TCT、HPV检测及阴道镜单独及联合检查CIN检出率,分析TCT、HPV检测单独及联合检查对CIN、CC的诊断效能。结果139例疑似CIN患者中,经病理学检查79例确诊为CIN,其中低度鳞状上皮内病变(LSIL)28例,高度鳞状上皮内病变(HSIL)37例,CC 14例。HPV、阴道镜检查CIN检出率高于TCT,差异有统计学意义(P<0.008);但HPV、阴道镜检查检出率比较,差异无统计学意义(P>0.008);TCT、HPV检测及阴道镜联合检查的检出率高于三者单独检查,差异有统计学意义(P<0.008)。以阴道镜下组织病理学结果为对照,TCT联合HPV筛查CIN、CC的敏感度、准确度、阴性预测值高于单独检查,差异有统计学意义(P<0.017);TCT、HPV单独及联合筛查CIN、CC的特异度、阳性预测值比较,差异无统计学意义(P>0.017)。结论TCT、HPV及阴道镜联合检查CIN可提高检出率,对筛查CC具有高敏感度,且可提高准确度。

Objective To analyze the application value of thinprep cytologic test(TCT),human papilloma virus(HPV)and colposcopy in the screening of cervical intraepithelial neoplasia(CIN)and cervical cancer(CC).Methods A total of 139 patients with suspected CIN received in Shangrao People's Hospital from January 2020 to April 2022 were selected as the research objects.TCT,HPV and colposcopy were performed at admission,and confirmed by pathological examination.The results were used as the diagnostic basis,the detection rates of CIN by TCT,HPV and colposcopy were compared,and the diagnostic efficacy of TCT,HPV and colposcopy were analyzed.Results Among 139 patients with suspected CIN,79 cases were diagnosed as CIN by pathological examination,including 28 cases of low grade squamous intraepithelial lesion(LSIL),37 cases of highly squamous intraepithelial lesions(HSIL)and 14 cases of CC.The detection rate of CIN in HPV and colposcopy was higher than that in TCT,the difference was statistically significant(P<0.008).However,there was no significant difference in the detection rate of HPV and colposcopy(P>0.008).The detection rate of TCT,HPV and colposcopy were higher than those of the three methods alone,the differences were statistically significant(P<0.008).Compared with the histopathological results under colposcopy,the sensitivity,accuracy and negative predictive value of TCT combined with HPV screening for CIN and CC were higher than those methods alone,the differences were statistically significant(P<0.017).There were no significant differences in the specificity and positive predictive value of CIN and CC screened by TCT and HPV alone or jointly(P>0.017).Conclusion The combined examination of TCT,HPV and colposcopy can improve the detection rate of CIN,has high sensitivity to CC screening,and can improve the accuracy.