液基薄层细胞学、高危型人乳头瘤病毒检查在宫颈癌及癌前病变筛查中的价值

陆亚玲; 张金玲; 许锬; 欧阳程欣; 张立杰

doi:10.16462/j.cnki.zhjbkz.2021.10.017

液基薄层细胞学、高危型人乳头瘤病毒检查在宫颈癌及癌前病变筛查中的价值

doi: 10.16462/j.cnki.zhjbkz.2021.10.017

1.
215123 苏州，苏州大学医学部公共卫生学院流行病与卫生统计学系
2.
518020 深圳，深圳市人民医院(暨南大学第二临床医学院南方科技大学第一附属医院)妇科

详细信息

通讯作者:
张金玲，E-mail: 398915490@qq.com

中图分类号: R181.1;R711.74
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出版历程
- 收稿日期: 2021-02-02
- 修回日期: 2021-05-03
- 网络出版日期: 2021-11-17
- 刊出日期: 2021-10-10

The value of liquid-based thinprep cytologic test and high-risk human papillomavirus test in the screening of cervical cancer and precancerous lesions

1.
Department of Epidemiology and Health Statistics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
2.
Department of Gynecology, Shenzhen People's Hospital (the Second Clinical Medical College, Jinan University; the First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, China

More Information

Corresponding author: ZHANG Jin-ling, E-mail: 398915490@qq.com

摘要

摘要: 目的评价与比较液基薄层细胞学检查(liquid-based thinprep cytologic test, TCT)、高危型人乳头瘤病毒(high-risk human papillomavirus, HR-HPV)检查在宫颈癌及癌前病变筛查中的价值，为宫颈癌及癌前病变单项筛查方法的选择提供初步依据。方法收集2006年2月25日―2019年10月15日在深圳市人民医院妇科因体检进行TCT、HR-HPV和阴道镜及组织病理学检查的5 657名女性资料。细胞学阳性结果包括未明确诊断意义的不典型鳞状上皮细胞(atypical squamous cells of undetermined significance, ASC-US)及以上病变。计数资料的比较采用χ²检验，采用Logistic回归分析模型分别分析HR-HPV感染、TCT阳性与宫颈癌及癌前病变(低度宫颈上皮内瘤变及以上病变)的关系。结果 HR-HPV阳性例数为3 857例，阳性率为68.18%。HR-HPV检查筛查宫颈癌及癌前病变的灵敏度、阳性预测值、阴性预测值均高于TCT(82.39% vs. 55.34%、51.80% vs. 47.35%、76.28% vs. 61.64%；均有P＜0.001)，但其特异度低于TCT(42.48% vs. 53.84%；P＜0.001)。Logistic回归分析模型结果显示，HR-HPV感染女性患宫颈癌及癌前病变的风险(OR=3.42, 95% CI: 3.02~3.88, P < 0.001)高于TCT阳性女性(OR=1.48, 95% CI: 1.33~1.65, P < 0.001)。结论 HR-HPV检查在宫颈癌及癌前病变筛查中的价值高于TCT。
- 液基薄层细胞学 /
- 人乳头瘤病毒 /
- 宫颈癌 /
- 宫颈上皮内瘤变 /
- 筛查
Abstract: Objective To evaluate and compare the value of liquid-based thinprep cytologic test (TCT) and high-risk human papillomavirus (HR-HPV) test in the screening of cervical cancer and precancerous lesions, and provide the preliminary basis for the selection of single screening method for cervical cancer and precancerous lesions. Methods The data of 5 657 women who underwent TCT, HR-HPV test, colposcopy and histopathological examinations for health examination in the gynecological outpatient department of Shenzhen People's Hospital from February 25, 2006 to October 15, 2019 were collected. Cytological positive results included atypical squamous cells of undetermined significance (ASC-US) and above lesions. Count data were compared using χ² test, and the Logistic regression analysis model was performed to analyze the relationship between HR-HPV infection, TCT positive and cervical cancer and precancerous lesions (low-grade cervical intraepithelial neoplasia and above lesions), respectively. Results The number of HR-HPV positive women (the positive rate) was 3 857 (68.18%). The sensitivity, positive predictive value, and negative predictive value of HR-HPV test in the screening of cervical cancer and precancerous lesions were all higher than TCT (82.39% vs. 55.34%, 51.80% vs. 47.35%, 76.28% vs. 61.64%; all P < 0.001), but its specificity was lower than TCT (42.48% vs. 53.84%, P < 0.001). Logistic regression analysis model showed that the risk of cervical cancer and precancerous lesions for HR-HPV positive women (OR=3.42, 95% CI: 3.02-3.88, P < 0.001) was higher than that for TCT positive women (OR=1.48, 95% CI: 1.33-1.65, P < 0.001). Conclusion The value of HR-HPV test in screening cervical cancer and precancerous lesions is higher than that of TCT.
- Liquid-based thinprep cytology /
- Human papillomavirus /
- Cervical cancer /
- Cervical intraepithelial neoplasia /
- Screening

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表 1 受检女性的基本特征[n(%)]

Table 1. Basic characteristics of the tested women [n(%)]

变量	受检女性
年龄(岁, x±s)
21~＜31	26.56±2.61
31~＜41	35.31±2.84
41~＜51	44.91±2.85
51~＜65	55.62±3.85
HR-HPV
阳性	3 857(68.18)
阴性	1 800(31.82)
TCT
ASC-US及以上病变	2 834(50.10)
正常	2 823(49.90)
病理
低度CIN及以上病变	2 425(42.87)
正常	3 232(57.13)

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表 2 TCT、HR-HPV检查筛查宫颈癌及癌前病变的评价分析[% (95% CI)]

Table 2. Evaluation and analysis of TCT and HR-HPV test in screening cervical cancer and precancerous lesions [% (95% CI)]

筛查方法	灵敏度	特异度	阳性预测值	阴性预测值	一致率
TCT	55.34(53.35~57.31)	53.84(52.11~55.55)	47.35(45.52~49.19)	61.64(59.83~63.41)	54.48(53.18~55.78)
HR-HPV	82.39(80.82~83.86)	42.48(40.79~44.19)	51.80(50.22~53.38)	76.28(74.26~78.19)	59.59(58.31~60.86)
P值	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 3 HR-HPV感染、TCT阳性与宫颈癌及癌前病变危险性分析

Table 3. The analysis of HR-HPV infection, TCT positive and the risk of cervical cancer and precancerous lesions

筛查方法	病理阳性例数	病理阴性例数	OR(95% CI)值	P值
HR-HPV	3 857	1 800	3.42(3.02~3.88)	＜0.001
TCT	2 834	2 823	1.48(1.33~1.65)	＜0.001

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