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目的:分析宫颈病变的4种检查方法:液基薄层细胞学检查(TCT)、阴道镜活检、人乳头瘤病毒(HPV)检测、宫颈环形电切术(LEEP)的临床应用价值。方法:收集2008年4月~2009年1月在本院宫颈门诊就诊的1308例患者,分析其TCT筛查结果,HPV-DNA检测结果,阴道镜指示下多点活检病理结果及LEEP手术病理结果。结果:(1)TCT检查1308例中,阳性182例,阳性率13.9%,TCT阳性报告中CIN及宫颈癌检出率85.7%。LSIL诊断符合率63.4%,HSIL诊断符合率86.7%。TCT漏诊率12.8%;(2)HPV检测212例,阳性检出率67.0%,HPV感染率与病理级别呈正相关,CINⅠHPV检出率59.3%,CINⅡHPV检出率77.4%,CINⅢHPV检出率96.0%,浸润癌HPV检出率达100%。HPV(+)组CIN检出率93.7%,HPV(-)组CIN检出率74.3%;(3)TCT(+)HPV(+)组中,CIN以上病变检出率95.3%;TCT(-)HPV(-)组中,CIN以上病变检出率58.8%,无1例CINⅢ以上的病变;(4)LEEP术后病理与阴道镜活检病理诊断完全符合率66.5%;CINⅠ符合率83.1%;CINⅡ符合率63.5%;CINⅢ符合率58.6%。术后病理级别下降24例(11.7%),术后病理级别上升45例(21.8%)。结论:TCT有较高的阳性筛查率,但有一定的误诊和漏诊。HPV有更好的阳性筛查率,HPV阳性与病理级别呈正相关。TCT与HPV结合能提高宫颈病变的检出率,尤其两者均阳性时预测价值更高。阴道镜活检较难发现宫颈上皮深处及宫颈管内病灶,LEEP手术可在一定程度上弥补活检的不足,达到诊断和治疗的目的,但存在影响病理诊断和过度治疗的问题。合理使用TCT、阴道镜检查、HPV检查及LEEP,可以提高宫颈病变的诊断率。
OBJECTIVE: To analyze four methods of cervical lesions: the clinical application of TCT, colposcopy biopsy, HPV, LEEP. Methods: A total of 1308 patients treated in our clinic from April 2008 to January 2009 were collected and analyzed for TCT screening results, HPV-DNA test results, multiple colposcopy biopsy findings under colposcopy, and LEEP surgical pathology results . Results: (1) Among 1308 TCT cases, 182 were positive, the positive rate was 13.9%. The positive rate of CIN and cervical cancer in TCT positive was 85.7%. LSIL diagnosis coincidence rate of 63.4%, HSIL diagnosis coincidence rate of 86.7%. TCT misdiagnosis rate of 12.8%; (2) 212 cases of HPV testing, the positive detection rate of 67.0%, HPV infection rate and pathological grade was positive, CIN Ⅰ HPP detection rate of 59.3%, CIN Ⅱ HPP detection rate of 77.4%, CIN Ⅲ HPP detection rate of 96.0% , Invasive cancer HPV detection rate of 100%. The detection rate of CIN was 93.7% in HPV (+) group and 74.3% in HPV (-) group. (3) The detection rate of CIN was 95.3% in TCT (+) HPV (+ ) In the HPV (-) group, the prevalence of lesions above CIN was 58.8%, and none of the above lesions were found in CINⅢ. (4) The pathological results of colorectal biopsy and colposcopy were 66.5% and 83.1%, respectively. CIN Ⅱ coincidence rate of 63.5%; CIN Ⅲ coincidence rate of 58.6%. Postoperative pathological grade decreased 24 cases (11.7%), postoperative pathological grade increased 45 cases (21.8%). Conclusion: TCT has a higher positive rate of screening, but some misdiagnosis and missed diagnosis. HPV has a better positive screening rate, HPV positive and pathological grade was positively correlated. TCT combined with HPV can improve the detection rate of cervical lesions, especially when both are more positive predictive value. Colposcopy biopsy harder to find the depths of cervical epithelium and cervical canal lesions, LEEP surgery can make up for the lack of biopsy to some extent, to achieve the purpose of diagnosis and treatment, but there are problems affecting the pathological diagnosis and over-treatment. Reasonable use of TCT, colposcopy, HPV testing and LEEP, can improve the diagnosis of cervical lesions.