高危型人乳头瘤病毒基因检测和液基细胞学在宫颈癌筛查中的联合应用  

Application of liquid-based cytology and high-risk human papillomavirus DNA test in the screening of cervical cancer

作　　者：孔令华[1] 金力[1] 程雪梅[1] 郎景和[1] 

机构地区：[1]中国医学科学院北京协和医院妇产科,北京100730

出　　处：《中国医刊》2012年第5期47-50,共4页Chinese Journal of Medicine

摘　　要：目的探讨薄层液基细胞学(TCT)检测和高危型人乳头瘤病毒基因(HR-HPV DNA)检测在子宫颈癌筛查中的临床应用。方法对有HR-HPV DNA检测和组织学结果的728例阳性TCT病例资料进行回顾性分析。结果 728例患者病理学诊断为正常、宫颈上皮内瘤变1(CIN1)、CIN2/3、子宫颈鳞癌、子宫颈腺癌、子宫内膜癌分别为152、310、238、22、1、5例,细胞学诊断为鳞状上皮内低度病变(LSIL)、鳞状上皮内高度病变(HSIL)、鳞状细胞癌(SCC)相对于CIN1/HPV、CIN2/CIN3、子宫颈鳞癌的符合率分别是54.7%、65.4%、85.7%;细胞学诊断为非典型腺细胞(AGC)、非典型鳞状细胞-意义不明(ASC-US)、非典型鳞状细胞-不除外上皮内高度病变(ASC-H)、LSIL、HSIL、SCC的患者分别是8、227、22、311、153、7例,其中HR-HPVDNA的阳性率分别是75%、85.5%、77%(17/22)、91.3%、93%、100%;TCT联合HR-HPV DNA检测与病理诊断CIN的符合率为82.5%,单纯TCT检查与病理诊断CIN的符合率为79.1%,两者比较差异无显著性;不同年龄组HR-HPV感染率、CIN发生率无显著性;以病理诊断≥CIN2为阳性结果,HR-HPV DNA检测在ASC-US患者中的敏感性、特异性、阳性预测值、阴性预测值分别是98.1%、14.0%、27.3%、96.7%。结论液基细胞学和HR-HPV DNA检测是子宫颈癌筛查的有效方法,HR-HPV DNA的检测有利于细胞学诊断为ASC-US的分流管理。Objective To explore the application of liquid-based cytol^gy（TCT） and high-risk human papillomavirus （HR-HPV） DNA test in cervical cancer screening. Methods The 728 patients who have the results of positive TCT, HR-HPV DNA and pathology in our department is analyzed retrospectively. Results Among the 728 patients, the ca- ses of pathological diagnosis of normal, cervical intraepithelial neoplasm 1 （ CIN1 ）, CIN2/3, were 152,310,238,22, 1,5, respectively, the coincidence between the results of TCT and pathology was 54.7% for low-grade squamous in- traepithelial lesion（LSIL） ,65.4% for high-grade intraepithelial lesion（HSIL） and 85.7% for squamous cell carci- noma （SCC） ;The cases of cytological diagnosis of atypical glandular cell （AGC）, atypical spuamous cells of undeter- mined significance（ ASC-US）, Aatypical squamous cells, ASC cannot exclude HSIL （ASC-H）, LSIL, HSIL, SCC were 8,227,22,31!, 153,7, respectively. Among them, the positive rate of HR-HPV of AGC, ASC-US, ASC-H, LSIL, HSIL, SCC was 75% ,85.5% ,77% ,91.3% ,93%, 100%, respectively. The coincidence on diagnosis of CIN between HR-HPV DNA combined cytological diagnosis and pathological diagnosis was 82.5%, which is slightly higher than 79.1%, the coincidence on diagnosis of CIN between cytological diagnosis and pathological diagnosis, and there is no significant difference between them;There is also no significant difference of HPV infection rate and incidence of CIN in different age groups;For detection of cervical intraepithelial neoplasia 2 or higher（ CIN2 ＋ ）, the sensitivity, specifitivity, positive prodictive value and negtive prodictive value of HR-HPV DNA test in the ASC-US group were 98.1%, 14.0% ,27.3% ,96.7%, respectively. Conclusion liquid-based cytology and HR-HPV DNA test are feasible for cervical cancer screaning program, HR-HPV DNA test is a goood triage approach for the patients with ASC-US.

关 键 词：宫颈癌 液基细胞学 高危型人乳头瘤病毒 非典型鳞状上皮 

分 类 号：R737.33[医药卫生—肿瘤]