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目的探讨宫颈薄层液基细胞学(TCT)联合高危型人乳头瘤病毒(HPV)检测在宫颈上皮内瘤变(CIN)筛查中的应用价值。方法选取2016年1-12月在保定市第一医院妇科行宫颈癌前病变筛查的5 000例妇女为研究对象,均行TCT检查,对于TCT检查结果阳性的患者行HPV检测及阴道镜下宫颈组织活检、组织病理学检查,以组织病理学检查结果为诊断的金标准,对检测结果进行分析。结果根据TBS分级标准,5 000例宫颈病变筛查患者标本检测结果显示,TCT阳性999例,其中意义不明确的非典型鳞状细胞(ASCUS)521例(52.15%)、低度鳞状上皮内病变(LSIL)263例(26.33%)、不除外高度鳞状上皮内病变的非典型鳞状上皮细胞(ASC-H)148例(14.81%)、高度鳞状上皮内病变(HSIL)67例(6.71%)。TCT阳性的999例患者中HPV阳性717例,HPV-DNA检测总阳性率为71.77%;HPV-DNA检测和组织病理学检查的阳性率随着TCT检查诊断级别的升高呈逐渐升高趋势;ASCUS、LSIL、ASC-H、HSIL联合HPV-DNA检测阳性符合率分别为80.16%、82.10%、99.26%、100.00%,说明TCT联合HPV-DNA检测结果与组织病理学诊断的符合率随着TCT诊断级别的升高呈上升趋势。结论HCT联合高危型HPV检测在CIN中检出符合率高,可有效降低漏诊率。
Objective To investigate the value of cervical smear-based cytology (TCT) combined with high-risk human papillomavirus (HPV) detection in cervical intraepithelial neoplasia (CIN) screening. Methods A total of 5 000 women with cervical precancerous lesions underwent gynecological examinations in the First Hospital of Baoding from January to December in 2016 were enrolled in this study. All patients underwent TCT for TCT, and underwent colposcopy Cervical biopsy, histopathological examination, the histopathological examination results for the gold standard of diagnosis, the test results were analyzed. Results According to the TBS grading standards, the test results of 5 000 cervical lesions screening patients showed that TCT was positive in 999 cases, of which 521 cases (52.15%) had undetermined significance of atypical squamous cells (ASCUS), low-grade squamous intraepithelial neoplasia There were 263 cases (26.33%) with LSIL, 148 cases (14.81%) with atypical squamous intraepithelial lesion and 67 cases with high grade squamous intraepithelial lesion (HSIL) 6.71%). The positive rate of HPV-DNA test and histopathological examination in 7 TCT-positive 999 patients was 717 and the positive rate of HPV-DNA test was 71.77%. The positive rate of HPV-DNA and histopathology increased gradually with the increase of diagnosis level of TCT. The positive coincidence rates of ASCUS, LSIL, ASC-H and HSIL combined with HPV-DNA test were 80.16%, 82.10%, 99.26% and 100.00%, respectively, indicating that the coincidence rate of TCT combined with HPV-DNA test and histopathological diagnosis was as high as TCT The level of diagnosis is on the rise. Conclusion HCT combined with high-risk HPV test detected in CIN with a high coincidence rate, which can effectively reduce the rate of misdiagnosis.