目的 探讨宫颈液基细胞学、高危型人类乳头瘤病毒(HPV)及联合检测对宫颈高级别鳞状上皮内病变及以上的检出情况。方法 选择2019年6-9月首都医科大学附属北京妇产医院妇科门诊手术室行阴道镜检查的病例1721例,对其宫颈液基细胞学、HPV及宫颈活检病理结果进行回顾性分析及统计。结果 1721例中, 年龄19~78岁,平均(41.04±10.84)岁。液基细胞学检测结果为不明意义的非典型鳞状细胞(ASC-US)、低级别鳞状上皮内病变(LSIL)、不能除外高度病变的非典型鳞状细胞 (ASC-H)、高级别鳞状上皮内病变(HSIL)及非典型腺细胞(AGC)中病理检测为HSIL及以上的检出率分别为22.6%、25.0%、77.3%、90.9%和60.0%,均高于液基细胞学检测结果为无上皮内病变或恶性病变(NILM)的检出率(14.2%),差异均有统计学意义(P＜0.05)。高危型HPV检测结果中,HPV16/18阳性和其他HR-HPV阳性中HSIL及以上检出率分别为22.8%和19.0%,均明显高于HPV阴性中的7.3%, 差异均有统计学意义(P＜0.05)。联合检测阳性656例中,HSIL及以上的检出率为31.3%(205例),明显高于联合检测非阳性组(1065例)的13.7%(146例),差异有统计学意义(χ2=76.93,P＜0.001)。结论 液基细胞学和高危型HPV检测是宫颈高级别鳞状上皮内病变及以上筛查的重要手段,应重视联合检测阳性的患者,提高检出率。
Abstract
Objective To explore the detection of high-grade squamous intraepithelial lesion or worse by thinprep cytologic test (TCT), high-risk human papillomavirus (HPV) detection and combined screening methods. Methods A total of 1721 women referred for colposcopy at gynecology clinic of Beijing Obstetrics and Gynecology Hospital from June to November of 2019 were included, and the results of TCT screening, HPV detection and cervical biopsy pathology were retrospectively analyzed. Results In the 1721 cases,the average age was 41.04±10.84 ranged from 19 to 78 years old. The detection rates of high-grade squamous intraepithelial lesions (HSIL) or worse by biopsy in AUSCUS, LSIL, ASC-H, HSIL and AGC groups were 22.6%, 25.0%, 77.3%, 90.9% and 60.0% respectively, which were significantly higher than that in NILM group (14.2%, P＜0.05). The detection rates of HSIL or worse by biopsy in HPV 16/18 positive and other HR-HPV positive groups were 22.8% and 19.0%, which were significantly higher than that in the HPV negative group (7.3%,P＜0.05). The detection rate of HSIL or worse in the positive group by TCT and HPV detection was 31.3% (205 /656), which was significantly higher than that in the control group(13.7%,146/1065; P<0.001). Conclusions TCT and high-risk HPV detection are important methods of screening HSILor worse. The patients with TCT ASC-US or worse combined with high-risk HPV should be paid more attention to improve the detection rate.
关键词
宫颈液基细胞学 /
高危型人类乳头瘤病毒 /
联合检测 /
宫颈高级别鳞状上皮内病变
Key words
thinprep cytologic test /
high-risk HPV /
TCT combined with high-risk HPV detection /
high-grade squamous intraepithelial lesions
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参考文献
[1] Siegel R L, Miller K D, Fuchs H E, et al. Cancer statistics, 2021[J]. CA Cancer J Clin, 2021, 71(1):7-33.
[2] 李婷婷,王翠峰.高危型人乳头瘤病毒联合宫颈液基薄层细胞学检测在宫颈上皮内瘤变筛查中的应用价值[J]. 中国全科医学, 2021. 24(9): 1106-1110.
[3] 赵 昀, 魏丽惠. CSCCP关于中国宫颈癌筛查及异常管理相关问题专家共识解读[J]. 实用妇产科杂志, 2018. 34(2): 101-104.
[4] Hu L, Bell D, Antani S, et al. An Observational study of deep learning and automated evaluation of cervical images for cancer screening[J]. J Natl Cancer Inst, 2019,111(9):923-932.
[5] 赵 超,赵 昀,崔淑慧, 等.高危型HPV及联合检测在子宫颈癌机会性筛查中的价值[J].中国妇产科临床杂志,2016,17(2):119-121.
[6] Wentzensen N, Clarke M A, Bremer R, et al. Clinical evaluation of human papillomavirus screening with p16/Ki-67 dual stain triage in a large organized cervical cancer screening program[J]. JAMA Intern Med, 2019,179(7):881-888.
[7] Lew J B, Simms K T, Smith M A, et al. Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program[J]. Lancet Public Health, 2017, 2(2): e96-e107.
[8] Wang W, Arca E, Sinha A, et al. Cervical cancer screening guidelines and screening practices in 11 countries: a systematic literature review[J]. Prev Med Rep. 2022, 8(28):101813.
[9] Chrysostomou A C, Stylianou D C, Constantinidou A, et al. Cervical cancer screening programs in Europe: the transition towards HPV vaccination and population-based HPV testing[J]. Viruses, 2018, 10(12):729.
[10] 沈 洁,高丽丽,张 月,等.北京市宫颈癌筛查妇女中高危型HPV感染状况及在宫颈癌前病变中的分布[J].中华预防医学杂志,2018,52(5):493-497.
[11] 靳梦杰,胡 倩,李 强,等.人染色体端粒酶基因、TCT结合HPV检测用于宫颈组织病变的诊断价值[J].武警医学,2021,32(12):1025-1029.
[12] Perkins R B, Guido R S, Castle P E, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors[J]. J Low Genit Tract Dis, 2020, 24(2):102-131.
[13] 吕 涛,吴 忧,廖秦平, 等.高危型人乳头瘤病毒E6/E7 mRNA在宫颈细胞学ASCUS/LSIL/ASC-H分流中的意义[J].现代妇产科进展,2017,26(9):670-673.
[14] 陆夏良,展 瑞,赵光明,等.人乳头状瘤病毒感染患者宫颈病理分析[J].中国临床医生杂志,2021,49(11):1364-1366.
[15] US Preventive Services Task Force, Curry S J, Krist A H, et al. Screening for cervical cancer: US preventive services task force recommendation statement[J]. JAMA, 2018, 320(7): 674-686.
[16] 赵 健,郭雯雯,冯 慧. 21～24岁年轻女性子宫颈癌筛查建议及子宫颈病变的处理[J].中国实用妇科与产科杂志,2020,36(7):608-616.
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