[联合高危型人乳头瘤病毒DNA检测与细胞学检测以发现早期宫颈发育异常]

[Combining high-risk human papillomavirus DNA test and cytological test to detect early cervical dysplasia].

作者信息

Qian De-ying, Cen Jian-min, Wang Ding, Zeng Ren-hai, Lin Ai-hua, Shu Yan-hong, Hong Dan-hua, Huang Zhi-hong

机构信息

Department of Obstetrics and Gynecology, Guangdong Provincial People's Hospital, Guangzhou 510080, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2006 Jan;41(1):34-7.

PMID:16635326

Abstract

OBJECTIVE

To assess the value of combining high-risk human papillomavirus (HPV) DNA test and cytological test in detection of early cervical dysplasia.

METHODS

During January 2003 to June 2004, a total of 5210 women were screened by combining high-risk HPV DNA test (hybrid capture II, HC-II) and cytological test (liquid-based ThinPrep cytology test), and the abnormal cytological or HPV DNA findings were further biopsied under the colposcope.

RESULTS

The age of the patients was between 17 to 80, the average was 34 +/- 9. Final pathological diagnosis was HPV infection in 890 cases, cervical intraepithelial neoplasia (CIN) I in 83 cases, CIN II in 73 cases, CIN III in 80 cases, invasive cervical cancer in 54 cases, endometrial cancer in 5 cases, vaginal intraepithelial neoplasia in 1 case and cervical tuberculosis in 1 case. Based on the criteria of histology and pathology, the sensitivity, specificity, positive-predictive value and negative-predictive value of high-risk HPV DNA test for detecting all cases of CIN II, III were 92.22%, 74.71%, 5.19% and 99.84% respectively. In detecting all cases of CIN II, III by cytological test, for atypical squamous cell of undetermined signification (ASCUS), the sensitivity, specificity, positive-predictive value and negative-predictive value were 90.00%, 80.34%, 11.94% and 99.63% respectively; for low-grade squamous intraepithelial lesion (LSIL), the sensitivity, specificity, positive-predictive value and negative-predictive value were 70.13%, 91.58%, 11.11% and 99.51% respectively; for high-grade squamous intraepithelial lesion (HSIL), the sensitivity, specificity, positive-predictive value and negative-predictive value were 48.05%, 98.46%, 31.90% and 99.21% respectively. By the combination of high-risk HPV DNA test and cytological test, the sensitivity, specificity, positive-predictive value and negative-predictive value for detecting all cases of CIN II, III were 98.70%, 73.08%, 5.21% and 100.00% respectively. The infection rate of HPV in cervical cancer was 85.2% (46/54), in CIN III 92.5% (74/80), in CIN II 86.3% (63/73) and in CIN I 45.8% (38/83).

CONCLUSIONS

High-risk HPV DNA test has high sensitivity and negative-predictive value. The combination of high-risk HPV DNA test and cytological test increases the sensitivity and negative-predictive value, but it does not increase the specificity. The performance of biopsy under the colposcope can help the diagnosis of cervical dysplasia.

摘要

目的

评估高危型人乳头瘤病毒（HPV）DNA检测与细胞学检测联合应用于早期宫颈发育异常检测中的价值。

方法

在2003年1月至2004年6月期间，共有5210名女性接受了高危型HPV DNA检测（杂交捕获二代，HC-II）与细胞学检测（液基薄层细胞学检测）联合筛查，对于细胞学或HPV DNA检测结果异常者，在阴道镜下进一步进行活检。

结果

患者年龄在17至80岁之间，平均年龄为34±9岁。最终病理诊断为HPV感染890例，宫颈上皮内瘤变（CIN）I级83例，CIN II级73例，CIN III级80例，浸润性宫颈癌54例，子宫内膜癌5例，阴道上皮内瘤变1例，宫颈结核1例。依据组织学和病理学标准，高危型HPV DNA检测对所有CIN II、III级病例的敏感性、特异性、阳性预测值和阴性预测值分别为92.22%、74.71%、5.19%和99.84%。通过细胞学检测对所有CIN II、III级病例进行检测时，对于意义不明确的非典型鳞状细胞（ASCUS），其敏感性、特异性、阳性预测值和阴性预测值分别为90.00%、80.34%、11.94%和99.63%；对于低级别鳞状上皮内病变（LSIL），其敏感性、特异性、阳性预测值和阴性预测值分别为70.13%、91.58%、11.11%和99.51%；对于高级别鳞状上皮内病变（HSIL），其敏感性、特异性、阳性预测值和阴性预测值分别为48.05%、98.46%、31.90%和99.21%。通过高危型HPV DNA检测与细胞学检测联合应用，对所有CIN II、III级病例进行检测时，其敏感性、特异性、阳性预测值和阴性预测值分别为98.70%、73.08%、5.21%和100.00%。宫颈癌中HPV感染率为85.2%（46/54），CIN III级中为92.5%（74/80），CIN II级中为86.3%（63/73），CIN I级中为45.8%（38/83）。