宫颈液基细胞学p16及其联合高危HPV检测在宫颈癌和癌前病变筛查中的诊断价值

Diagnostic value of cervical liquid-based cytology p16 and its combination with high-risk HPV detection in screening cervical cancer and precancerous lesions

目的评价宫颈液基细胞学检测p16及其联合高危人乳头状瘤病毒(HR-HPV)检测在宫颈癌和癌前病变筛查中的诊断价值。方法选取2018年1月—2019年8月在北京大学第一医院妇产科就诊并接受液基细胞学p16、液基细胞学检查(LBP)、高危HPV检测的女性900例分析筛查结果,阳性患者转诊阴道镜活检。根据活检病理结果,评估不同筛查策略对宫颈高级别病变的识别效能。结果p16表达阳性率随细胞学严重程度和宫颈病变程度的加重而升高。p16识别高级别病变的敏感度和阴性预测值最高,分别为0.969、0.995;LBP敏感度最低(0.853),但特异度最高(0.859);HR-HPV阳性预测值和准确率最低,分别为0.328、0.700,差异有统计学意义(P<0.05)。HPV+LBP、p16+HPV 2种联合筛查模式敏感度分别为0.969、0.992。特异度分别为0.634、0.643,差异无统计学意义(P>0.05)。结论单独p16、p16+HPV均可以高效识别宫颈高级别病变。p16方便易操作,有助于简化筛查策略,具有更好的推广和实际临床应用价值。

Objective To evaluate the diagnostic value of cervical liquid-based cytology detection p16 and its combination with high-risk human papillomavirus(HR-HPV)detection in screening cervical cancer and precancerous lesions.Methods Select 900 women who received liquid-based cytology p16,liquid-based cytology(LBP)and high-risk HPV test in the Department of Obstetrics and Gynecology of Peking University First Hospital from January 2018 to August 2019 to analyze the screening results.Positive patients were referred to colposcopy biopsy.According to the pathological results of biopsy,evaluate the recognition efficiency of different screening strategies for high-level cervical lesions.Results The positive rate of p16 expression increased with the severity of cytology and the severity of cervical lesions.P16 has the highest sensitivity and negative predictive value for identifying high-level lesions,0.969 and 0.995 respectively.LBP has the lowest sensitivity(0.853),but the highest specificity(0.859).HR-HPV positive predictive value and accuracy rate were the lowest,0.328 and 0.700 respectively,with statistically significant difference(P<0.05).The sensitivity of HPV+LBP and p16+HPV combined screening modes was 0.960 and 0.992 respectively.The specificity was 0.634 and 0.643 respectively,with no significant difference(P>0.05).Conclusion p16 and p16+HPV alone can effectively identify high-level cervical lesions.p16 is convenient and easy to operate,helps to simplify the screening strategy,and has better promotion and practical clinical application value.