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目的:了解4种不同检查方法在宫颈癌筛查中的临床应用价值。方法:采用第二代杂交捕获技术(hy-brid capture 2,HC-II)检测13种高危型人乳头瘤病毒(human papillomavirus,HPV)、薄层液基细胞学技术(Liq-uid-based cytology test,LCT)检测宫颈脱落细胞、醋酸肉眼检查(visual inspection with acetic acid,VIA)和阴道镜检查4种方法对2004年11月～2004年12月深圳南山区华侨城区域15～59岁有性生活女性共1 137例进行盲法同步宫颈癌筛查。对阴道镜检查异常或可疑异常者行阴道镜下直接活检;对HPV阳性并且LCT≥未明确诊断意义的不典型鳞状上皮细胞(atypical squamous cells of undetetemined sign,ASCUS),或HPV阴性但LCT≥低度鳞状上皮内病变(low grade squamous intraepithelial lesion,LSIL)的妇女再次行阴道镜下活组织病理学检查,以病理结果作为验证4种检查方法的金标准。结果:共取病理122例。病理结果证实该人群中无宫颈癌病例:子宫颈上皮内瘤变(cervicalintraepithelial neoplasia,CIN)Ⅲ级3例,CINⅡ级11例,CINⅠ级36例;慢性宫颈炎和鳞状上皮化生69例;正常宫颈3例。人群的高危HPV总检出率为14.0%;LCT阳性率为12.6%;VIA阳性率为12.5%;阴道镜阳性率为13.6%。随宫颈病变级别升高,高危HPV感染率及LCT阳性率均呈趋势性增加(P<0.005);VIA和阴道镜阳性率在各级宫颈病变中无统计学差异,但在宫颈病变组阳性检出率明显高于正常宫颈组。高危HPV对宫颈高度病变的敏感性、特异性、准确性、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为100%、87.1%、87.3%、8.8%、100%、7.6%和0;LCT以上各指标分别为92.9%、88.4%、88.5%、9.1%、99.9%、8.0%和8.0%;VIA以上各指标分别为35.7%、96.0%、95.3%、10.0%、99.2%、8.9%和67.0%;阴道镜以上各指标分别为50.0%、86.8%、86.4%、4.5%、99.3%、3.8%和58.0%。结论:高危HPV检测和LCT检查均为目前宫颈癌筛查较好的方法,VIA和阴道镜检查敏感性较差,漏诊率高,不适合大范围筛查,但二者阴性预测值均较高,可应用于临床病例诊断。
Objective: To understand the clinical value of four different screening methods in cervical cancer screening. METHODS: Thirteen high-risk human papillomavirus (HPV) and liq-uid-based cytology (HPV) were detected by the second generation hybridization capture technique (HC-II) test, LCT) detection of cervical exfoliated cells, visual inspection with acetic acid (VIA) and colposcopy four methods of November 2004 ~ December 2004 in Shenzhen OCT area 15 to 59 years of sexual life A total of 1,137 women were blindly screened for cervical cancer. Colposcopic direct biopsy of colposcopy abnormalities or suspicious abnormalities; atypical squamous cells of undetected sign (ASCUS) for HPV positive and LCT ≧ undefined diagnoses, or HPV negative but LCT ≧ The women with low grade squamous intraepithelial lesion (LSIL) underwent colposcopy biopsy pathology again. The pathological results were used as the gold standard to verify the four methods. Results: A total of 122 cases of pathology. The pathological results confirmed that there were no cases of cervical cancer in this population: 3 cases of cervical intraepithelial neoplasia (CIN) Ⅲ, 11 cases of CINⅡ, 36 cases of CINⅠ, 69 cases of chronic cervicitis and squamous metaplasia, 3 cases of normal cervix. The total population of high-risk HPV was 14.0%; the positive rate of LCT was 12.6%; the positive rate of VIA was 12.5%; the positive rate of colposcopy was 13.6%. With the increase of cervical lesions, the high-risk HPV infection rate and LCT positive rate showed a trend of increase (P <0.005); VIA and colposcopy positive rate in all levels of cervical lesions was no significant difference, but in cervical lesions positive test Rate was significantly higher than the normal cervical group. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of high risk HPV to cervical lesions were 100%, 87.1%, 87.3%, 8.8%, 100% 7.6%, and 0; the indexes above LCT were 92.9%, 88.4%, 88.5%, 9.1%, 99.9%, 8.0% and 8.0% respectively; the VIA above indicators were 35.7%, 96.0%, 95.3%, 10.0% 99.2%, 8.9% and 67.0% respectively. The above indexes of colposcopy were 50.0%, 86.8%, 86.4%, 4.5%, 99.3%, 3.8% and 58.0% respectively. Conclusions: High-risk HPV test and LCT are the best screening methods for cervical cancer. VIA and colposcopy are less sensitive and have a higher rate of misdiagnosis, which is not suitable for large-scale screening. However, the negative predictive value of both is high , Can be applied to the diagnosis of clinical cases.