TCT联合HR-HPV检测在宫颈癌及癌前病变中的临床价值

Clinical Value of TCT Combined HR-HPV Testing in Cervical Cancer and Precancer

目的探讨薄层液基细胞学检查(thinprep cytologic test,TCT)阳性的患者行高危人乳头状瘤病毒(HR-HPV)检测在宫颈癌及癌前病变诊断中的临床价值。方法对2011年5月—2013年5月在沙湾县妇幼保健院妇科门诊就诊的2 147例患者行TCT。结果阳性的477例患者同时进行HPV检测和阴道下宫颈活检,以组织病理学结果作为诊断的金标准。结果宫颈活检组织病理学诊断结果为:477例患者中,宫颈炎240例,占50.31%;CINⅠ138例,占28.93%;CINⅡ-Ⅲ78例,占16.35%;宫颈浸润癌21例,占4.40%。HR-HPV检测阳性者共有226例,阳性率随病变严重程度的增加而增加。CINⅠ级及其以上病变检出率在HR-HPV检测阳性组中明显高于阴性组,两组比较差异有统计学意义(P<0.05)。结论 TCT能有效降低宫颈癌发病率,但会造成一部分漏诊情况的发生;HR-HPV检测可以减少单纯应用TCT而造成的宫颈病变漏诊率,并对细胞学结果有进一步的分流作用。

OBJECTIVE To analyze the clinical value of HR-HPV testing for the diagnosis of cervical cancer and precancerous lesionsin women with abnormal liquid based cytology.METHODS A retrospective study was carried out on patients whose liquid based cy-tology were abnormal in 477 cases all subjects were examined by HR-HPV testing and colposcopy directed biopsy. RESULTS In477 cases patients with abnormal TCT cervicitis was 240 cases,accounting for 50.31%,CIN I was 138 cases,accounting for was28.93%, 78 cases of CIN II-Ⅲ was 16.35%, cervical carcinoma was 21 cases, accounting for 4.40%. 267 cases was HR-HPVpositive, the positive rate was increased with the severity of disease. CIN I level and above lesion detection rate was significantlyhigher in HR-HPV positive group than that of negative group in HR-HPV detection,there were significant differences between twogroups(P<0.05). CONCLUSION TCT could reduce the incidence of cancer effectively. But it may cause missed diagnosis.HPV-DNA detection could reduce the rate of misdiagnosis in simple application of liquid based cytology on cervical lesions, andthere was further shunt function for cytology results.