3种不同方法在宫颈癌筛查分流中的价值对比分析  

Comparison of friage value between three different technical methods in cervical cancer screening

作　　者：袁明明 葛婷婷 章小霞 陶玉梅 姜林甫 朱国祥 黄国琴 任晓燕 YUAN Ming-ming;GE Ting-ting;ZHANG Xiao-xia;TAO Yu-mei;JIANG Ling-fu;ZHU Guo-xiang;HUANG Guo-qin;REN Xiao-yan(Department of Pathology,Affiliated Matern&Child Care Hospital of Nantong University,Nantong 226018,China)

机构地区：[1]南通大学附属南通妇幼保健院(南通市妇幼保健院),江苏南通226018

出　　处：《诊断病理学杂志》2024年第6期508-512,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨液基细胞学检测(TCT)、DNA定量分析以及人乳头瘤病毒(HPV)检测3种技术方法在宫颈癌筛查中的应用及诊断价值。方法以病理组织学结果为金标准,通过TCT、DNA定量分析以及HPV 3种方法对其诊断准确性、灵敏度、特异度、阳性预测值、阴性预测值等进行比较分析。结果300例患者中,病理组织学131例为宫颈炎症,117例为低级别鳞状上皮内病变(LSIL),43例为高级别鳞状上皮内病变(HSIL),9例为鳞状细胞癌(SCC)。TCT的诊断灵敏度92.90%、特异度88.55%、符合率91.00%;DNA的诊断灵敏度95.86%、特异度91.60%、符合率94.00%;HPV的诊断灵敏度97.63%、特异度81.68%、符合率90.67%;TCT+HPV联合的诊断灵敏度98.22%、特异度80.92%、符合率90.67%;DNA+HPV联合的诊断灵敏度99.41%、特异度81.68%、符合率91.67%。工作特征曲线(ROC)分析结果为AUC(HPV)>AUC(DNA)>AUC(DNA+HPV)>AUC(TCT+HPV)>AUC(TCT)。结论TCT+HPV及DNA+HPV两种联合筛查方案降低了漏诊率。运用HPV初筛结合DNA定量分析进行分流的方法准确性会比3种方法单独筛查更高。Objective To explore the application and diagnostic value Thinprep cytologic test(TCT),DNA quantitative DNA analysis and human papillomavirus(HPV)detection in cervical cancer screening.Methods In this paper,using histopathological findings as the gold standard,and their diagnostic accuracy,sensitivity,specificity,positive predictive value and negative predictive value were compared and analysed by three screening method,namely TCT,quantitative DNA analysis and HPV testing.Results Of the 300 cases,the pathological diagnosis was cervical inflammation in 131 cases,117 were low-grade squamous intraepithelial lesions(LSIL),43 were high-grade squamous intraepithelial lesions(HSIL),and 9 were squamous epithelial cell carcinoma(SCC).The diagnostic sensitivity of TCT was 92.90%,specificity was 88.55%,accordance rate was 91.00%;the diagnostic sensitivity of DNA was 95.86%,specificity was 91.60%,accordance rate was 94.00%;the diagnostic sensitivity of HPV was 97.63%,specificity was 81.68%,accordance rate was 90.67%;the diagnostic sensitivity of TCT+HPV was 98.22%,specificity was 80.92%,accordance rate was 90.67%;the diagnostic sensitivity of DNA+HPV was 99.41%,specificity was 81.68%,accordance rate was 91.67%.The results of the working characteristic curve(ROC)analysis were AUC(HPV)>AUC(DNA)>AUC(DNA+HPV)>AUC(TCT+HPV)>AUC(TCT).Conclusion Screening with both TCT+HPV and DNA+HPV combination tests reduces the rate of missed diagnoses but increases the rate of misdiagnosis.The use of primary screening for HPV and quantitative DNA analysis for triage will be more accurate than screening for all three tests individually.

关 键 词：宫颈癌 液基细胞学 DNA定量分析 HPV检测 分流 

分 类 号：R737.33[医药卫生—肿瘤]