TCT及HPV检测与阴道镜检查在宫颈癌前病变和宫颈癌筛查中的应用价值

Application value of TCT,HPV detection and colposcopy in cervical precancerous lesions and cervical cancer screening

目的探讨宫颈薄层液基细胞学(TCT)、人乳头瘤病毒(HPV)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。方法选择2018年3月—2021年4月于商丘市第一人民医院进行检查的疑似宫颈病变患者90例,均行TCT、HPV检测及阴道镜检查。以病理结果作为诊断“金标准”,分析TCT、HPV检测及阴道镜检查的检查结果,分析三种检查方法单独及联合检测在宫颈癌及宫颈癌前病变中的诊断价值,另分析单独及联合检测与病理结果的一致性。结果90例疑似宫颈病变患者,经病理组织学检查明确为宫颈病变患者31例,包括宫颈癌4例(TCT阳性2例,HPV阳性3例,阴道镜4例),HISL16例(TCT阳性11例,HPV阳性14例,阴道镜15例),LSIL11例(TCT阳性7例,HPV阳性10例,阴道镜9例)。联合检查临床应用价值均高于TCT、HPV、阴道镜单项检查,有统计学差异(P<0.05)。kappa检验显示:TCT与病理结果的一致性不佳(kappa值=0.151,P=0.123);HPV与病理结果的一致性尚可(kappa值=0.530,P=0.000);阴道镜与病理结果的一致性尚可(kappa值=0.655,P=0.000);联合检查与病理结果的一致性良好(kappa值=0.927,P=0.000)。结论TCT、HPV检测及阴道镜联合检查在宫颈癌前病变及宫颈癌筛查中具有较高的临床应用价值,与病理结果一致性较强,对早期鉴别诊断宫颈病变具有重要作用,值得推广应用。

Objective To explore the application value of cervical thin-layer liquid-based cytology(TCT),human papillomavirus(HPV)detection and colposcopy in cervical precancerous lesions and cervical cancer screening.Methods A total of 90 patients with suspected cervical lesions who were examined in our hospital from March 2018 to April 2021 were selected,and all underwent TCT,HPV detection and colposcopy.Taking the pathological results as the“gold standard”for diagnosis,the results of TCT,HPV detection and colposcopy were analyzed,the diagnostic value of the three inspection methods alone and in combination in cervical cancer and cervical precancerous lesions were analyzed,and the consistency of the pathological results with the single and combined detection was also analyzed.Results Among the 90 patients with suspected cervical lesions,31 were confirmed to be cervical lesions by histopathological examination,including 4 cases of cervical cancer(2 cases of TCT positive,3 cases of HPV positive,4 cases of colposcopy),16 cases of HISL(11 cases of TCT positive,14 cases of HPV positive,15 cases of colposcopy),11 cases of LSIL(7 cases of TCT positive,10 cases of HPV positive,9 cases of colposcopy).The clinical application value of combined examination was higher than that of TCT,HPV and colposcopy alone,with statistical differences(P<0.05).The kappa test showed that the consistency between TCT and pathological results was poor(kappa value=0.151,P=0.123);the consistency between HPV and pathological results was acceptable(kappa value=0.530,P=0.000);the consistency between colposcopy and pathological results was acceptable(kappa value=0.655,P=0.000);the consistency between combined examination and pathological results was good(kappa value=0.927,P=0.000).Conclusion TCT,HPV detection and colposcopy combined examination have high clinical application value in the screening of cervical precancerous lesions and cervical cancer,and have strong consistency with pathological results.They play an important role in the early differential diagnosis of cervical lesions,and is worth popularizing.