30岁以下机会性筛查宫颈高级别病变风险分析

Health Care of China.March 2024,Vol.39,No.5 Risk analysis of opportunistic screening for high-grade cervical lesions under 30 years of age

目的筛选组织病理证实为宫颈高级别病变(CIN2+包括CIN2、CIN3、鳞癌)、≤30岁妇女的筛查资料,分析其筛查效力。方法回顾性分析2019年1月—2020年12月就诊于厦门市妇幼保健院、年龄≤30岁妇女的宫颈癌机会性筛查资料,以组织病理诊断为金标准,分析其临床症状、液基细胞学(LCT)、人乳头瘤病毒(HPV)检测及组织活检结果的特点。结果273例高级别病变患者中,25~30岁占81.3%(222/273),18~24岁占18.7%(51/273),差异有统计学意义(P<0.05);临床症状因主诉不适者占72.2%(197/273),无不适者占27.8%(76/273),差异有统计学意义(P<0.05);液基细胞阳性率84.6%(231/273),人乳头瘤病毒(HPV)阳性率98.2%(268/273);液基细胞学判读构成比最高为Ascus,占31.1%(85/273),HPV感染中单一型别占49.8%(136/273),混合型别占48.4%(132/273),差异无统计学意义(P>0.05);HPV感染分型最高的6个亚型依次为HPV 16、52、58、18、33、51;组织活检CIN2占70.7%(193/273),CIN3占27.8%(76/273),宫颈鳞状细胞癌4例,其中18~24岁CIN2占78.4%,CIN3占21.6%;25~30岁CIN2占68.9%,CIN3占29.3%,鳞状细胞癌4例。结论30岁以下妇女CIN2+发病率处于较高水平,HPV16、52、58、18、33、51是主要感染型别,重视液基细胞判读为Ascus的分流,HPV分型检测能提高CIN2+的识别力,液基细胞联合HPV分型检测为高质量的筛查方案。

Objective To screen the screening data of women≤30 years old with histopathologically confirmed high-grade cervical lesions(CIN2+including CIN2,CIN3,squamous cell carcinoma)and analyze the screening efficacy.Methods The data of cervical cancer opportunistic screening in patients aged≤30 years who were admitted to Xiamen Maternal and Child Health Hospital from January 2019 to December 2020 were retrospectively analyzed,using histopathological diagnosis as the gold standard,and the characteristics of clinical symptoms,liquid based cytology(LCT),human papillomavirus(HPV)detection and biopsy results were analyzed.Results Among the 273 patients with high-grade lesions,81.3%(222/273)were aged 25-30 years old and 18.7%(51/273)were aged 18-24 years old,the difference was statistically significant(P<0.05).In clinical symptoms,72.2%(197/273)of patients complained of discomfort,27.8%(76/273)without discomfort,the difference was statistically significant(P<0.05).The positive rate of liquid based cells was 84.6%(231/273)and the positive rate of human papillomavirus(HPV)was 98.2%(268/273).The highest proportion of liquid cytological interpretation was Ascus 31.1%(85/273),single type was 49.8%(136/273),mixed type was 48.4%(132/273),and the difference was not statistically significant(P>0.05).The six subtypes with the highest HPV infection types were 16,52,58,18,33,51,respectively.Biopsy CIN2 accounted for 70.7%(193/273),CIN3 accounted for 27.8%(76/273),4 cases of cervical squamous cell carcinoma,of which 18-24 years old CIN2 accounted for 78.4%,CIN3 accounted for 21.6%;There were 68.9%CIN2 and 29.3%CIN3 in 25 to 30 years old,4 cases of squamous cell carcinoma.Conclusion The incidence of CIN2+in women under 30 years old is at a high level,and HPV16,52,58,18,33,51 are the main infection types.Attention should be paid to the shingling of liquid-based cells interpreted as Ascus.HPV typing can improve the recognition of CIN2+,and liquid-based cell combined HPV typing is a high-quality screening program.