阴道镜检查、HR-HPV检测、p16检测在子宫颈癌筛查中的价值

Value of Colposcopy Examination,HR-HPV Examination,p16 Examination in Cervical Cancer Screening

目的:分析阴道镜检查、高危型人乳头瘤病毒(high-risk human papilloma virus,HR-HPV)检测、p16检测在子宫颈癌(cervical cancer,CC)筛查中的价值。方法:回顾性分析2019年12月—2022年12月厦门市第五医院病理科收治的218例CC筛查患者的临床资料。所有患者均行阴道镜检查、HR-HPV检测、p16检测、病理检查。以病理结果为金标准。统计病理检查结果。分析阴道镜检查、HR-HPV检测、p16检测单独和联合检测结果。分析三种方法及联合与病理检查的一致性。分析阴道镜检查、HR-HPV检测、p16检测在CC筛查中的价值。结果:病理结果显示,218例患者中正常/炎症90例(41.28%),子宫颈上皮内瘤变Ⅰ(CINⅠ) 63例(28.90%),子宫颈上皮内瘤变Ⅱ(CINⅡ)和子宫颈上皮内瘤变Ⅲ(CINⅢ)53例(24.31%),CC 12例(5.50%)。阴道镜检查、HR-HPV检测、p16检测和联合检测的阳性率分别为53.67%、58.26%、57.34%、58.72%。阴道镜检查、HR-HPV检测、p16检测和联合与病理检查的Kappa值分别为0.619、0.821、0.878、0.962(P<0.001),且联合的Kappa值均高于其他方法。联合的敏感度、特异度、准确率、阳性预测值、阴性预测值均高于阴道镜检查、HR-HPV检测,差异有统计学意义(P<0.05)。结论:p16检测、HR-HPV检测及阴道镜检查联合在CC筛查中的应用价值更高。

Objective:To analyze the value of colposcopy examination,high-risk human papilloma virus(HR-HPV)examination,p16 examination in cervical cancer(CC)screening.Method:The clinical data of 218 patients with CC screening admitted to Pathology Department of Xiamen Fifth Hospital from December 2019 to December 2022 were retrospectively analyzed.All patients underwent colposcopy examination,HR-HPV examination,p16 examination,and pathological examination.Using pathological results as the gold standard,the results of pathological examination were counted.The results of colposcopy examination,HR-HPV examination,p16 examination alone and combination were analyzed.The consistency of the three methods and their combination with pathological examination was analyzed.The value of colposcopy examination,HR-HPV examination and p16 examination in CC screening was analyzed.Result:Pathological results showed that 90 cases(41.28%)of the 218 patients were normal/inflammatory,63 cases(28.90%)of cervical intraepithelial neoplasiaⅠ(CINⅠ),53 cases(24.31%)of cervical intraepithelial neoplasiaⅡ(CINⅡ)and cervical intraepithelial neoplasiaⅢ(CINⅢ),and 12 cases(5.50%)of CC.The positive rates of colposcopy examination,HR-HPV examination,p16 examination and combination examination were 53.67%,58.26%,57.34%and 58.72%respectively.The Kappa values of colposcopy examination,HR-HPV examination,p16 examination and combination and pathological examination were 0.619,0.821,0.878 and 0.962 respectively(P<0.001),and the combination Kappa values were higher than those of other methods.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combination were higher than those of the three methods alone,the differences were statistically significant(P<0.05).Conclusion:The combination of p16 examination,HR-HPV examination and colposcopy examination has higher application value in CC screening.