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目的:探讨早期宫颈癌盆腔淋巴结中高危型人乳头瘤病毒(HR-HPV)的分布及其预测淋巴转移的价值。方法:采用第2代杂交捕获技术(HC-Ⅱ)对新鲜的盆腔淋巴结进行13种HR-HPV DNA的检测,分析HR-HPV与病理结果的关系。结果:38例早期宫颈癌患者原发肿瘤中,HR-HPV阳性37例(97.4%),盆腔淋巴结阳性23例(60.5%),组织病理学确诊有淋巴结转移18例(47.4%),HR-HPV阳性与淋巴结阳性分布规律呈一致性,以闭孔淋巴结较多见。有盆腔淋巴结转移的HPV-DNA阳性率为73.9%,HPV-DNA阴性率为6.7%,差异有统计学意义,P<0.001。HR-HPV诊断早期宫颈癌发生盆腔淋巴转移的敏感度和特异度分别为94.4%和70.0%,阳性预测价值和阴性预测价值分别为73.9%和93.3%;HR-HPV阳性发生盆腔淋巴结转移的风险是HR-HPV阴性的39.67倍〔OR(95%CI)=39.67(4.26～369.65)〕。结论:HC-Ⅱ检测淋巴结中HR-HPV是敏感的且不破坏淋巴组织,检测HR-HPV是预测宫颈癌淋巴结转移的重要因素,但判断宫颈癌复发尚需进一步探讨。
Objective: To investigate the distribution of high-risk human papillomavirus (HR-HPV) in pelvic lymph nodes of early cervical cancer and its value in predicting lymphatic metastasis. Methods: Thirteen kinds of HR-HPV DNA were detected in fresh pelvic lymph nodes by the second generation hybridization capture technique (HC-Ⅱ), and the relationship between HR-HPV and pathological results was analyzed. Results: The positive rate of HR-HPV in 38 primary cervical cancer patients was 37 (97.4%), 23 (60.5%) were positive for pelvic lymph node, 18 (47.4%) were histopathologically diagnosed with lymph node metastasis, HR- HPV-positive and lymph node positive distribution was consistent with closed-cell lymph nodes more common. The positive rate of HPV-DNA with pelvic lymph node metastasis was 73.9%, and the negative rate of HPV-DNA was 6.7%, the difference was statistically significant, P <0.001. The sensitivity and specificity of HR-HPV in the diagnosis of pelvic lymphatic metastasis of early cervical cancer were 94.4% and 70.0%, respectively. The positive predictive value and negative predictive value of HR-HPV were 73.9% and 93.3% respectively. HR-HPV positive pelvic lymph node metastasis 39.67 folds of HR-HPV negative [OR (95% CI) = 39.67 (4.26-369.65)]. Conclusion: The detection of HR-HPV in lymph nodes by HC-Ⅱ is sensitive and does not destroy lymphoid tissue. Detection of HR-HPV is an important factor in predicting cervical lymph node metastasis. However, it is necessary to further investigate cervical cancer recurrence.