Wang Jian
Department of Obstetrics and Gynecology, Institution Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, China.
Braz J Med Biol Res. 2018 Nov 23;52(1):e7517. doi: 10.1590/1414-431X20187517.
The aim of this study was to explore the value of different combination schemes of liquid-based cytology (LBC) and high-risk human papilloma virus (HPV) test in the screening of high-grade (≥CIN 2) cervical lesions. From 5727 women who had undergone examinations with LBC and high-risk HPV test, 1884 patients with positive results of either or both LBC and HPV test were included in this study and underwent cervical biopsy. Based on the pathological examination results, comparisons of the assessment indicators of all diagnostic tests were made, and the application values of LBC and high-risk HPV test and different combination schemes of the two in the screening of high-grade (≥CIN II) cervical lesions were estimated. Compared with the single test method, the sensitivity and negative predictive value of the combination scheme of LBC+HPV (with one positive result) were increased significantly (98.7% and 99.7%), but the specificity (60.8%) and accuracy rate (65.4%) dropped significantly (P<0.05). The sensitivity of LBC+HPV (with two positive results) was the lowest (80.7%), but the specificity and accuracy rate were the highest (83.5% and 83.1%, P<0.05). Z test showed that differences in the screening efficiency of four schemes were not statistically significant (P>0.05). Both LBC and HPV test were effective methods in the screening of high-grade cervical lesions; combination of the two tests did not improve the screening efficiency, but the scheme of LBC+HPV (with two positive results) significantly increased the sensitivity and negative predictive value, which was of better cost-benefit value.
本研究旨在探讨液基细胞学检查(LBC)与高危型人乳头瘤病毒(HPV)检测不同联合方案在高级别(≥CIN 2)宫颈病变筛查中的价值。从5727例接受LBC和高危型HPV检测的女性中,纳入1884例LBC和/或HPV检测结果为阳性的患者,并进行宫颈活检。根据病理检查结果,对所有诊断试验的评估指标进行比较,评估LBC、高危型HPV检测及其不同联合方案在高级别(≥CIN II)宫颈病变筛查中的应用价值。与单项检测方法相比,LBC+HPV(一项阳性结果)联合方案的灵敏度和阴性预测值显著提高(98.7%和99.7%),但特异度(60.8%)和准确率(65.4%)显著下降(P<0.05)。LBC+HPV(两项阳性结果)的灵敏度最低(80.7%),但特异度和准确率最高(83.5%和83.1%,P<0.05)。Z检验显示,四种方案的筛查效率差异无统计学意义(P>0.05)。LBC和HPV检测均为高级别宫颈病变筛查的有效方法;两种检测联合并未提高筛查效率,但LBC+HPV(两项阳性结果)方案显著提高了灵敏度和阴性预测值,具有更好的成本效益价值。