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目的:探讨经阴道三维彩色血管能量成像(3D-CPA)技术、高危型人乳头瘤病毒(HR-HPV)及液基细胞学(TCT)联合检测对高级别宫颈上皮内瘤变(CIN)及早期宫颈癌的诊断价值。方法:选取2012年6月~2014年12月在该院宫颈门诊就诊的患者为研究对象,分别接受3D-CPA、HR-HPV及TCT检查,以上3项指标任一阳性者行阴道镜下活检,病理诊断为金标准。选取慢性宫颈炎52例、低级别CIN 50例、高级别CIN 80例、早期宫颈癌(Ⅰa-Ⅱa)35例进行分析。评价3种筛查方法单独或联合筛查共5种方案的灵敏度、特异度、诊断符合率及约登指数。结果:早期宫颈癌组血管形成指数(VI)大于高级别CIN组及低级别CIN组,差异均有统计学意义(P<0.01);3组血管形态及分级比较,差异均有统计学意义(P<0.05);3种筛查方法单独筛查发现:灵敏度最高为HPV(89.70%),特异度最高为VI(80.77%),诊断符合率最高为HPV(85.25%)。HPV+TCT与HPV+TCT+VI联合筛查发现:灵敏度和特异度最高均为三者联合筛查,灵敏度为96.36%,特异度为75%,诊断符合率为91.24%,约登指数最高为0.715。HPV16/18阳性患者宫颈癌组占94.29%,高级别CIN组占55.00%,低级别CIN组占21.57%。结论:3D-CPA、HR-HPV及TCT联合检测可提高宫颈病变筛查的灵敏度及准确度,应加强对HPV16/18阳性患者的筛查。
Objective: To investigate the clinical value of transvaginal three-dimensional color-angiography (3D-CPA), high-risk human papillomavirus (HR-HPV) and liquid-based cytology (TCT) in detecting high grade cervical intraepithelial neoplasia Diagnostic value of early cervical cancer. Methods: The patients who visited the clinic from June 2012 to December 2014 were enrolled in this study. They were examined by 3D-CPA, HR-HPV and TCT respectively. All three of them were examined by colposcopy biopsy , Pathological diagnosis as the gold standard. 52 cases of chronic cervicitis, 50 cases of low grade CIN, 80 cases of high grade CIN and 35 cases of early stage cervical cancer (Ⅰa-Ⅱa) were selected for analysis. To evaluate the sensitivity, specificity, diagnostic coincidence rate and Youden index of five kinds of screening methods alone or in combination. Results: The angiogenesis index (VI) in early cervical cancer group was higher than that in high-grade CIN group and low-grade CIN group (P <0.01). The vascular morphology and grading of three groups were statistically significant P <0.05). The results of three screening tests showed that the highest sensitivity was HPV (89.70%), the highest specificity was VI (80.77%) and the highest diagnostic coincidence rate was HPV (85.25%). The combined screening of HPV + TCT and HPV + TCT + VI found that the highest sensitivity and specificity were all combined screening, the sensitivity was 96.36%, the specificity was 75%, the diagnostic coincidence rate was 91.24%, the Youden index was the highest 0.715. HPV16 / 18 positive patients with cervical cancer accounted for 94.29%, high-grade CIN group accounted for 55.00%, low-grade CIN group accounted for 21.57%. Conclusion: The combined detection of 3D-CPA, HR-HPV and TCT can improve the sensitivity and accuracy of screening for cervical lesions. Screening for HPV16 / 18 positive patients should be strengthened.