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目的:探讨人乳头状瘤病毒(HPV)检测对绝经后诊断为意义不明的不典型鳞状细胞(atypicalsquamous cells of undetermined significance,ASCUS)绝经后妇女宫颈上皮细胞内瘤样病变(CIN)诊断的临床价值。方法:回顾性分析应用超薄液基细胞技术(TCT)行宫颈脱落细胞学检查进行机会性宫颈癌筛、查诊断为ASCUS的339例绝经后患者的资料,并分析HPV分型检测和阴道镜下宫颈组织活检及病理检查对检出宫颈病变的效率。结果:339例绝经后ASCUS人群中,HPV感染率为23.89%(81/339)。不同年龄区间(47~59岁、60~69岁)HPV感染率分别为28.49%(49/172)和19.16%(32/167),差异有统计学意义(P=0.044)。以病理诊断为高级别CIN(≥CIN2)作为临界终点,分析显示HPV检查用于预测宫颈CIN的敏感度为90.91%(10/11),特异度为78.35%(257/328),阳性预测值和阴性预测值分别为12.34%(10/81)和99.6%(257/258)。结论:HPV检测可用于绝经后患者ASCUS的分流诊治,阴性预测价值高。对于60~69岁绝经后ASCUS患者,若无HPV感染,建议随访,无需立即行阴道镜检查。
Objective: To investigate the clinical value of human papillomavirus (HPV) in the diagnosis of atypical squamous cells of undetermined significance (ASCUS) in the diagnosis of cervical intraepithelial neoplasia (CIN) in postmenopausal women value. Methods: The data of 339 cases of postmenopausal women with ASCUS diagnosed as ASCUS were retrospectively analyzed by cervical cytology (LCT) with ultrathin liquid-based cytology (TCT), and HPV genotyping and colposcopy Lower cervical biopsy and pathological examination of the detection of cervical lesions efficiency. Results: In 339 postmenopausal ASCUS population, the HPV infection rate was 23.89% (81/339). The HPV infection rates in different age groups (47-59 years old, 60-69 years old) were 28.49% (49/172) and 19.16% (32/167), respectively, with significant difference (P = 0.044). The pathological diagnosis of high-grade CIN (≥CIN2) as the critical endpoint, the analysis showed that the HPV test for the prediction of cervical CIN sensitivity was 90.91% (10/11), specificity was 78.35% (257/328), the positive predictive value And negative predictive values were 12.34% (10/81) and 99.6% (257/258), respectively. Conclusion: The HPV test can be used in the diagnosis and treatment of ASCUS in postmenopausal patients, with high negative predictive value. For postmenopausal ASCUS patients aged 60-69 years, if no HPV infection, the proposed follow-up, without colposcopy immediately.