摘要
目的探讨单独或联合应用液基薄层细胞学检查(TCT)、人乳头瘤病毒(HPV)DNA检测、HPV E6/E7 mRNA检测等方法对宫颈病变患者的筛查效能,为临床宫颈癌筛查提供参考方法。方法收集2017年6月至2018年12月于郑州大学第一附属医院行宫颈组织病理检查且同时行TCT检测、HPV DNA检测、HPV E6/E7 mRNA检测的814例患者。以组织病理学检查结果为金标准,比较不同级别宫颈病变组织中TCT、HPV DNA、HPV E6/E7 mRNA等3种检测方法的阳性率,单独或联合检测宫颈病变的敏感性、特异性、阳性预测值、阴性预测值及约登指数。结果814例患者组织病理学检查示,炎症456例(56.02%),低级别宫颈上皮内病变145例(17.81%),高级别宫颈上皮内病变184例(22.60%),宫颈浸润癌29例(3.57%),其中包括鳞癌23例(2.83%)、腺癌6例(0.74%)。TCT、HPV E6/E7 mRNA的阳性率随病变程度升级而升高(P<0.05)。TCT、HPV DNA、HPV E6/E7 mRNA、TCT+HPV DNA、TCT+HPV E6/E7 mRNA等5种筛查方法中,联合筛查优于单独筛查,HPV DNA敏感性最高(93.43%)、特异性最低(9.15%),TCT+HPV DNA与TCT+HPV E6/E7 mRNA敏感性一致(71.83%),但TCT+HPV E6/E7 mRNA筛查特异性更高(75.87%vs 63.39%)。所有筛查方法中TCT+HPV E6/E7 mRNA约登指数最高(0.48)。结论TCT+HPV E6/E7 mRNA对宫颈癌具有较高筛查效能。
Objective To investigate the diagnostic efficacy of thinprep cytologic test(TCT),human papillomavirus(HPV)DNA,HPV E6/E7 mRNA in patients with cervical lesions alone or in combination,in order to provide reference for clinical screening of cervical cancer.Methods From June 2017 to December 2018,in the First Affiliated Hospital of Zhengzhou University,814 patients underwent cervical histopathological examination and were simultaneously screened by TCT HPV DNA and HPV E6/E7 mRNA methods.The pathology diagnosis of cervical biopsy under colposcopy was taken as the golden standard,the positive rates among cervical lesions of different grades were compared,and the sensitivity,specificity,positive predictive value,negative predictive value and Youden index were calculated,of the TCT,HPV DNA,HPV E6/E7 mRNA test and their joint detection.Results Among the 814 cases,456 cases(56.02%)were confirmed negative by pathological biopsy,145 cases(17.81%)were low-grade cervical squamous intraepithelial lesion,184 cases(22.60%)were high-grade cervical squamous intraepithelial lesion,29 cases(3.57%)were cervical invasive carcinoma,including 23 cases of squamous cell carcinomas(2.83%)and 6 cases of adenocarcinoma(0.74%).The positive rates of TCT and HPV E6/E7 mRNA increased with the progression of lesion degree(P<0.05).Among the five screening methods of TCT,HPV DNA,HPV E6/E7 mRNA,TCT+HPV DNA,and TCT+HPV E6/E7 mRNA,the combined screening were better than the individual screening overall,HPV DNA had the highest sensitivity(71.83%)and the lowest specificity(9.15%),TCT+HPV DNA and TCT+HPV E6/E7 mRNA had same sensitivity(71.83%),but TCT+HPV E6/E7 mRNA had higher specificity(75.87%vs 63.39%).Among all the screening methods,the Yoden index of TCT+HPV E6/E7 mRNA was the highest(0.48).Conclusion The screening strategy of TCT+HPV E6/E7 mRNA has higher screening efficiency for cervical cancer.
作者
刘孝敏
韩丽萍
孙嘉敏
钟云
LIU Xiaomin;HAN Liping;SUN Jiamin;ZHONG Yun(Department of Gynaecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《肿瘤基础与临床》
2019年第5期405-409,共5页
journal of basic and clinical oncology
基金
河南省高校科技创新团队支持计划(18IRTSTHN024)
国家自然科学基金(U1604172)
河南省医学科技攻关计划项目(201701002)
作者简介
刘孝敏(1994-),女,硕士在读,主要从事妇科肿瘤及内分泌研究。E-mail:495998474@qq.com;通信作者:韩丽萍(1969-),博士,教授,主任医师,主要从事妇科肿瘤及内分泌研究。E-mail:hanliping0825@163.com。
