液基薄层细胞学检查、人乳头状瘤病毒检测及阴道镜检查在宫颈癌前病变及宫颈癌筛查中的应用价值  

Application value of thin-prep cytology test,human papillomavirus test and colposcopy in the screening of cervical precancerous lesions and cervical cancer

作　　者：罗晶 李婷婷 王倩[1] 付晓飞 秦海霞[1] 侯瑞杰[1] 秦瑞英[1] 王世进[1] LUO Jing;LI Tingting;WANG Qian;FU Xiaofei;QIN Haixia;HOU Ruijie;QIN Ruiying;WANG Shijin(Department of Gynecology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院妇科,河南卫辉453100

出　　处：《新乡医学院学报》2021年第5期427-430,435,共5页Journal of Xinxiang Medical University

基　　金：河南省高等学校重点科研项目(编号:19A320030)。

摘　　要：目的探讨液基薄层细胞学检测(TCT)、人乳头状瘤病毒(HPV)检测、阴道镜检查在宫颈癌前病变及宫颈癌筛查中的应用价值。方法回顾性分析2019年5月至2020年4月于新乡医学院第一附属医院同时行TCT、HPV检测及阴道镜检查的459例疑似宫颈病变患者的临床资料。以组织学结果为“金标准”,分析TCT、HPV检测、阴道镜检查在宫颈癌前病变及宫颈癌筛查中的价值。结果459例疑似宫颈病变患者经宫颈活体组织检查确诊为宫颈病变者157例,其中低级别鳞状上皮内病变59例、高级别鳞状上皮内病变80例、宫颈癌18例。459例疑似宫颈病变患者中,TCT筛查阳性292例(阳性率63.62%),HPV筛查阳性342例(阳性率74.51%),TCT和HPV联合筛查阳性456例(阳性率99.35%)。TCT在宫颈癌前病变及宫颈癌诊断中的灵敏度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率、准确度分别为63.69%(100/157)、36.42%(110/302)、34.25%(100/292)、65.87%(110/167)、63.58%(192/302)、36.31%(57/157)、47.93%(220/459);HPV检测在宫颈癌前病变及宫颈癌诊断中的灵敏度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率、准确度分别为89.17%(140/157)、33.11%(100/302)、40.94%(140/342)、85.47%(100/117)、66.89%(202/302)、10.83%(17/157)、52.29%(240/459);TCT和HPV联合检测在宫颈癌前病变及宫颈癌诊断中的灵敏度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率、准确度分别为98.73%(155/157)、0.33%(1/302)、33.99%(155/456)、33.33%(1/3)、99.67%(301/302)、1.27%(2/157)、33.99%(156/459)。HPV检测在宫颈癌前病变及宫颈癌诊断中的灵敏度、阴性预测值高于TCT检测,假阴性率低于TCT(P<0.05);TCT与HPV检测在宫颈癌前病变及宫颈癌诊断中的特异度、阳性预测值、假阳性率、准确度比较差异无统计学意义(P>0.05)。TCT和HPV联合检测在宫颈癌前病变及宫颈癌诊断中的灵敏度、假阳性率�Objective To investigate the value of thin-prep cytology test(TCT),human papillomavirus(HPV)test and colposcopy in the screening of cervical precancerous lesions and cervical cancer.Methods The clinical data of 459 patients with suspected cervical lesions who underwent TCT,HPV test and colposcopy in the First Affiliated Hospital of Xinxiang Medical University from May 2019 to April 2020 were retrospectively analyzed.The value of TCT,HPV and colposcopy in cervical precancerous lesions and cervical cancer screening were analyzed based on the histological results.Results Among the 459 cases of suspected cervical lesions,157 cases were diagnosed as cervical lesions by cervical biopsy,including 59 cases of low-grade squamous intraepithelial lesion,80 cases of high-grade squamous intraepithelial lesion and 18 cases of cervical cancer.Among the 459 patients with suspected cervical lesions,292(63.62%)cases were positive by TCT,342(74.51%)cases were positive by HPV,and 456 cases(99.35%)were positive by TCT combined with HPV.The sensitivity,specificity,positive predictive value,negative predictive value,false positive rate,false negative rate and accuracy of TCT in the diagnosis of cervical precancerous lesions and cervical cancer were 63.69%(100/157),36.42%(110/302),34.25%(100/292),65.87%(110/167),63.58%(192/302),36.31%(57/157)and 47.93%(220/459),respectively.The sensitivity,specificity,positive predictive value,negative predictive value,false positive rate,false negative rate and accuracy of HPV detection in the diagnosis of cervical precancerous lesions and cervical cancer were 89.17%(140/157),33.11%(100/302),40.94%(140/342),85.47%(100/117),66.89%(202/302),10.83%(17/157)and 52.29%(240/459),respectively.The sensitivity,specificity,positive predictive value,negative predictive value,false positive rate,false negative rate and accuracy of TCT combined with HPV in the diagnosis of cervical precancerous lesions and cervical cancer were 98.73%(155/157),0.33%(1/302),33.99%(155/456),33.33%(1/3),99.67%(301/302),1.27%(2/157)and 3

关 键 词：液基薄层细胞学检查 人乳头状瘤病毒 阴道镜检查 宫颈癌前病变 宫颈癌 筛查 

分 类 号：R737.33[医药卫生—肿瘤]