宫颈细胞学检查为意义不明确的非典型鳞状细胞患者的分流处理探讨  

Exploring in management of women with atypical squamous cells of undetermined significance

作　　者：张宏珍[1] 张巧玉[1] 成争先[1] 温娜[1] 陈小燕[1] 

机构地区：[1]中国人民解放军第三○九医院妇产科,北京100091

出　　处：《重庆医学》2012年第6期573-574,577,共3页Chongqing medicine

摘　　要：目的探讨高危型人乳头状瘤病毒(HPV)DNA检测对宫颈细胞学检查为意义不明确的非典型鳞状上皮细胞(AS-CUS)患者宫颈疾病诊断的临床意义和价值。方法 2008年7月至2010年11月,对本院新柏膜式液基超薄细胞学检查(TCT),且诊断结果为ASCUS的218例患者进行高危型HPV-DNA检测及阴道镜下活检。结果 218例ASCUS患者病理组织学结果为宫颈上皮内瘤变(CIN)52.29%,高级别CIN及宫颈浸润癌的发生率15.14%。阴道镜拟诊CIN 94例,与宫颈组织学病理检查结果相符68例,阴道镜评估与病理诊断符合率为59.65%,高危型HPV-DNA阳性组CIN检出率为85.84%,明显高于阴性组的16.19%,差异有统计学意义(P<0.05)。高级别CIN 33例中31例高危HPV-DNA检测阳性,仅2例CINⅡ为阴性。宫颈浸润癌2例,高危HPV检测为阳性。结论高危型HPV-DNA检测是一种有效的ASCUS分流管理手段,能提高CIN的检出率。Objective To find the sensitivity,specificity,and positive and negative predictive values of the high-risk group human papillomavirus（HPV） DNA testing as a triage tool to detect in women with a cytologic smear showing atypical squamous cells of undetermined significance（ASCUS）.Methods All new cases with cytologic smears showing ASCUS presented in our hospital from July 2008 to November 2010,excluding known cases of HSILs and pregnancies,were enrolled.Cervical cell samplings were done by cervical cytobrush technique and tested for high-risk group HPV with the hybrid capture 2（HC2） test.All participants were examined under a colposcope.Then cervicographs were taken before colposcopic-directed cervical biopsies were done.Results Among patients investigated,114 patients were diagnosed with cervical intraepithelial neoplasia（CIN,52.29%）.Comparing the colposcopic result with biopsied result,the coincidence rate was 59.65% in high grade CIN and squamous cell carcinoma（SCC）.The prevalence of CIN in the high-risk HPV group was 85.84% and was obviously higher than that of HPV-negative group（P0.05）.31 of 33 patients with high grade CIN were HPV-positive,2 patients were HPV-negative,2 cases were high-risk HPV positive.Conclusion High-risk group HPV detection can be used as an additional triage test to detect HSILs in women having ASCUS with high sensitivity and negative predictive value.

关 键 词：宫颈上皮内瘤样病变 意义不明确的非典型鳞状细胞 人乳头状瘤病毒 

分 类 号：R737.33[医药卫生—肿瘤]