TCT与阴道镜在HR-HPV阳性女性子宫颈高级别及以上鳞状上皮内病变诊断中的应用价值  

TCT and colposcopy in detection of high⁃grade cervical lesions in high⁃risk HPV positive women

作　　者：贾小平 吴婵玉[2] 周静 李韵霞 姜敏[2,4] 阿依江 马彩玲 JIA Xiao-ping;WU Chan-yu;ZHOU Jing;LI Yun-xia;JIANG Min;A Yi-jiang;MA Cai-ling(不详;Department of Gynecology,The First Affiliated Hospital of Xinjiang Medical University,Xinjiang 830054,China)

机构地区：[1]新疆医科大学第一附属医院妇科,乌鲁木齐830054 [2]克拉玛依市中心医院妇科 [3]新疆消化系统肿瘤精准临床医学研究中心 [4]新疆临床基因检测与生物信息重点实验室

出　　处：《妇产与遗传（电子版）》2023年第1期25-29,共5页Obstetrics-Gynecology and Genetics (Electronic Edition)

基　　金：新疆维吾尔自治区自然科学基金(2021D01A21);克拉玛依市创新人才工程(2019RC001 A⁃14)。

摘　　要：目的探讨宫颈液基细胞学(thinprep cytologic test,TCT)与阴道镜检查在高危型HPV阳性(high⁃risk human papillomavirus,HR⁃HPV)女性人群中诊断宫颈高级别及以上病变(high grade squamous intraepithelia lesion and above,HSIL+)的临床应用价值。方法收集克拉玛依市中心医院2018年1月至2021年11月的宫颈HR⁃HPV阳性病例2445例,回顾性分析TCT诊断、阴道镜诊断与组织病理学诊断的相符情况,比较TCT、阴道镜及阴道镜结合TCT诊断HSIL+的情况。结果TCT诊断与组织学诊断符合率为84.25%,一致性检验Kappa值为0.565。阴道镜诊断与组织学诊断符合率为88.30%,一致性检验Kappa值为0.69。TCT诊断HSIL+的灵敏度是60.69%,特异度是92.53%;阴道镜诊断HSIL+的灵敏度是74.52%,特异度是93.15%;阴道镜结合TCT结果诊断HSIL+的灵敏度是79.09%,特异度是86.07%。细胞学诊断HSIL+的受试者工作特征曲线下面积(Area Under Curve,AUC)为0.766,阴道镜诊断HSIL+的AUC为0.838,阴道镜结合TCT诊断HSIL+的AUC为0.826。结论在宫颈HR⁃HPV阳性女性中,阴道镜诊断宫颈HSIL+的临床价值较高,阴道镜结合TCT可以提高诊断HSIL+的灵敏度,减少HSIL+的漏诊率。Objective To explore the clinical application value of thinprep cytologic test(TCT)and colposcopy in the diagnosis of high-grade and above cervical lesions and above(HSIL+)in high-risk HPV positive cases.Methods 2445 cervical high-risk HPV(HR-HPV)positive cases in Karamay Central Hospital from January 2018 to November 2021 were collected.The coincidence be-tween the initial diagnosis of TCT,colposcopy and cervical pathological diagnosis was analyzed retro-spectively to compare the application value of TCT,colposcopy and TCT combined with colposcopy in the diagnosis of HSIL+.Results The coincidence rate between TCT diagnosis and histological diag-nosis was 84.25%,and the Kappa value of consistency test was 0.565.The coincidence rate between colposcopy diagnosis and histological diagnosis was 88.30%,and the Kappa value of consistency test was 0.69.The sensitivity and specificity of TCT in the diagnosis of HSIL+were 60.69%and 92.53%,respectively.The sensitivity and specificity of colposcopy in the diagnosis of HSIL+were 74.52%and 93.15%,respectively.The sensitivity and specificity of TCT combined with colposcopy in the diagno-sis of HSIL+were 79.09%and 86.07%.The Area Under Curve(AUC)of cytological diagnosis of HSIL+was 0.766,the AUC of colposcopy diagnosis of HSIL+was 0.838,and the AUC of TCT com-bined with colposcopy diagnosis of HSIL+was 0.826.Conclusions In cervical HR-HPV positive women,the value of colposcopy in detecting cervical HSIL+is better than TCT.TCT combined with colposcopy could improve the sensitivity of detecting HSIL+and reduce the missed diagnosis rate of cervical HSIL+.

关 键 词：阴道镜 宫颈肿瘤 宫颈上皮内病变 人乳头瘤病毒 宫颈液基细胞学 

分 类 号：R711[医药卫生—妇产科学]