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目的探讨高危型人乳头瘤病毒(HR-HPV)、液基细胞学(TCT)检测结合阴道镜下定位活检对宫颈癌及癌前病变筛查的应用价值。方法收集我院妇科门诊HR-HPV、TCT检测患者1436例,对HR-HPV阳性、TCT≥ASCUS及临床高度怀疑宫颈病变患者共856例在阴道镜检查时行肉眼醋酸(VIA)及卢戈氏碘液(VILI)检查,并行定位活检。结果病理结果证实CINⅡ-619例,CINⅡ+237例,人群HR-HPV总检出率为71.4%,TCT阳性率82.5%,VIA阳性率63.0%,VILI阳性率53.4%。各种筛查方法阳性率在CINⅡ-、CINⅡ+中有统计学差异(P<0.05);HR-HPV对宫颈高度病变的敏感度、特异度、阳性似然比、正确诊断指数和Kappa值分别为89.03%、34.89%、1.37、0.2392和0.1605。TCT以上各指标为92.83%、21.49%、1.18、0.1432和0.0889。VIA以上各指标为86.08%、45.88%、1.59、0.3196和0.2294。VILI以上各指标为86.92%、59.45%、2.14、0.4637和0.3605。结论 TCT检查是一种准确、简便的宫颈病变的细胞学检测方法,结合HR-HPV检测,是宫颈癌前病变的最佳筛查方案;但也有假阴性,必要时要结合VIA、VILI阴道镜下定位活检明确,以免漏诊。
Objective To investigate the value of high-risk human papillomavirus (HR-HPV), liquid-based cytology (TCT) combined with colposcopy biopsy in the screening of cervical cancer and precancerous lesions. Methods A total of 1436 cases of HR-HPV and TCT were collected from gynecology clinic in our hospital. A total of 856 patients with HR-HPV positive, TCT≥ASCUS and highly suspected cervical lesions were examined with colitis (VIA) and Lugol’s Iodine solution (VILI) examination, parallel biopsy. Results The results of pathology confirmed that CINⅡ-619 and CINⅡ + 237 cases. The total positive rate of HR-HPV was 71.4%, TCT positive rate was 82.5%, VIA positive rate was 63.0% and VILI positive rate was 53.4%. The positive rates of various screening methods were statistically different between CINⅡ- and CINⅡ + (P <0.05). The sensitivity, specificity, positive likelihood ratio, correct diagnostic index and Kappa value of HR-HPV in cervical hyperplastic lesions were respectively 89.03%, 34.89%, 1.37, 0.2392 and 0.1605 respectively. The above TCT indicators were 92.83%, 21.49%, 1.18, 0.1432 and 0.0889. VIA above indicators were 86.08%, 45.88%, 1.59,0.3196 and 0.2294. VILI above indicators were 86.92%, 59.45%, 2.14,0.4637 and 0.3605. Conclusion TCT examination is an accurate and simple method for cytological detection of cervical lesions. Combined with HR-HPV detection, TCT is the best screening program for cervical precancerous lesions. However, TCT is also a false negative, and when necessary, combined with VIA, VILI colposcopy Under biopsy positioning clear, so as not to miss diagnosis.