宫颈疾病液基细胞学和人乳头状瘤病毒脱氧核糖核酸联合检测及与组织学对照研究.docVIP

1050例宫颈疾病液基细胞学和人乳头状瘤病毒核酸联合检测及与组织学对照研究 陶琨 杨静 杨华 郭振华 陈向宇* 孟晓彦* 王春蕾* 唐龙英* 左绪磊* 上海市长宁区中心医院病理科；*妇产科，上海 200336 摘要 目的：探讨TCT联合HCII HPV DNA检测诊断宫颈病变的价值，并总结TCT诊断中漏诊误诊的原因。 方法：收集上海市长宁区中心医院2006年-2009年行TCT、HCII HPV DNA检测及阴道镜活检的病例共1050例，分别比较了TCT、HCII HPV DNA及TCT联合HCII HPV DNA检测的诊断效能。对照组织学诊断结果，分析了TCT漏诊误诊的原因。结果：TCT中LSIL/HSIL与组织学的符合率高于NILM/ASUCS（P0.01）；HPV感染率随病变程度加重而逐步增加（P0.01）；TCT联合HCII HPV DNA检测的敏感性、阴性预测值均显著提高（P0.01）；TCT诊断的假阳性的原因主要是对反应性细胞及变性细胞的误诊，而假阴性则是对个别挖空细胞和异形细胞的漏诊。结论：TCT联合HCII HPV DNA检测可以显著提高宫颈病变诊断效能，从而对宫颈癌的早期预防、早期发现、早期治疗有积极的作用。正确的取材、规范的制片、准确的识别反应性细胞、挖空细胞和核深染的异形细胞，将有效的降低假阳性和假阴性的发生。 关键词 液基细胞学；第二代杂交捕获乳乳头状瘤病毒核酸检测；联合检测；宫颈上皮内瘤变 A Study of TCT Combined with HPV DNA Test and Biopsy-control in 1050 Cases of Cervical Lesion. TAO Kun YANG Jing YANG Hua GUO Zhen-hua CHEN Xiang-yu* MENG Xiao-yan* WANG Chun-lei* TANG Long-ying * ZUO Xulei* Department of Pathology, *Department of Obstetrics and Gynecology,Shanghai Changning District Hospital, Shanghai 200336,China. Corresponding author: * ZUO Xulei,E-mail:xulei_zuo@ present address: Department of Obstetrics and Gynecology, Jinshan Hospital affiliated to Fudan University Shanghai Medical College,200540,Shanghai Abstract Objective To investigate the value of Thinprep cytologic test(TCT) combined with human papilloma virus Hybrid Capture II( HPV HCII) test in cervical intraepithelial neoplasia and summarize the reasons for misinterpreting/missing diagnosis. Methods Patients(n=1050) with TCT，HCII HPV test and routine biopsy under colposcopy encountered between 2006-2009 in Shanghai Changning District hospital. According to cervical biopsy diagnosis, we analyzed the causes of false-positive and false-negative in TCT diagnosis and compared the diagnostic efficiency among TCT, HCII HPV test, TCT combined with HCII HPV test. Results The rates of LSIL/HSIL accordance with biopsy were higher than NILM/ASCUS(P0.01).HPV infection was increased with the degree of cervical lesions(P0.01).The sensitivity and negative predictive value were