宫颈HPVE6/E7检测联合计算机辅助诊断TCT及阴道炎检测在宫颈细胞学筛查中的应用价值

Application value of cervical HPV E6/E7 detection combined with computer-aided diagnosis of TCT and vaginitis detection in cervical cytology screening

目的 分析宫颈人乳头瘤病毒(HPV)E6/E7检测联合计算机辅助诊断宫颈液基细胞学(TCT)及阴道炎检测在宫颈细胞学筛查中的应用价值。方法 采用宫颈HPVE6/E7检测、计算机辅助诊断TCT、阴道炎检测法和阴道炎+TCT+HPVE6/E7检测对2023年2~8月在北京市昌平区中西医结合医院检查的1 586例女性进行宫颈癌筛查,发现181例疑似高级别鳞状上皮内病变(HSIL)病例,对疑似“HSIL”追加病理检查,并以病理检查作为金标准,分析上述筛查4种方法对HSIL的检出率及病理检查结果的一致性,并计算4种筛查方法对HSIL诊断的灵敏度和特异度。结果 181例疑似HSIL患者经病理检查发现共86例HSIL患者。阴道炎检测对HSIL的检出率为16.57%,Kappa值为0.488。计算机辅助诊断TCT检测对HSIL的检出率为24.86%,Kappa值为0.554。宫颈HPVE6/E7检测对HSIL的检出率为19.34%,Kappa值为0.512。阴道炎+TCT+HPVE6/E7检测对HSIL的检出率为38.67%,Kappa值为0.742。阴道炎+TCT+HPVE6/E7检测的AUC值>0.85,预测价值较高,灵敏度、特异度分别为81.40%、84.21%;阴道炎检测、TCT检测、HPVE6/E7检测的AUC值均>0.70,预测价值一般,各检测方法灵敏度、特异度分别为34.88%、52.63%,52.33%、61.05%,40.70%、64.21%。结论 宫颈HPVE6/E7、计算机辅助诊断TCT及阴道炎检测联合筛查可在一定程度上提升宫颈病变的检出率,对宫颈病变诊断具有明显指导意义。

Objective To analyze the application value of cervical human papillomavirus(HPV) E6/E7 detection combined with computer-aided diagnosis of cervical liquid-based cytology(TCT) and vaginitis detection in cervical cytology screening.Methods Cervical HPVE6/E7 detection,computer-aided diagnosis TCT,vaginitis detection and vaginitis+TCT+HPVE6/E7 detection were used to screen cervical cancer in 1 586 women examined in Beijing Changping Hospital of Integrated Chinese And Western Medicine from February to August 2023,and 181 cases of suspected high-grade squamous intraepithelial lesions(HSIL) were found.The suspected HSIL was subjected to additional pathological examination,and the pathological examination was used as the gold standard.The detection rate of HSIL and the consistency of pathological examination results of the above four screening methods were analyzed.The sensitivity and specificity of the four screening methods in the diagnosis of HSIL were calculated.Results A total of 86 HSIL patients were found in 181 patients with suspected HSIL by pathological examination.The detection rate of HSIL by vaginitis detection was 16.57 %,and the Kappa value was 0.488.The detection rate of HSIL by computer-aided diagnosis TCT was 24.86 %,and the Kappa value was 0.554.The detection rate of HSIL by cervical HPVE6/E7 detection was 19.34 %,and the Kappa value was 0.512.The detection rate of HSIL by vaginitis+TCT+HPVE6/E7 was 38.67%,and the Kappa value was 0.742.The AUC value of vaginitis+TCT+HPVE6/E7 detection was >0.85,and the predictive value was high.The sensitivity and specificity were 81.40% and 84.21%,respectively.The AUC values of vaginitis detection,TCT detection and HPVE6/E7 detection were all>0.70,and the predictive value was general.The sensitivity and specificity of each detection method were 34.88% and 52.63%,52.33% and 61.05%,40.70% and 64.21%,respectively.Conclusion The combined screening of cervical HPVE6/E7,computer-aided diagnosis TCT and vaginitis detection can improve the detection rate of cervical lesions to a certain extent,and has obvious guiding significance for the diagnosis of cervical lesions.