李瑞珍, 乌兰娜, 刘植华①, 王 倩②, 李俊华①, 李 晴①, 李 霓③, 刘志红, 石菊芳③, 张长淮, 周艳秋, 刘 彬③, 翁雷明, 吴瑞芳, 乔友林③. 4 种不同检查方法在宫颈癌筛查中的临床应用价值*[J]. 中国肿瘤临床, 2009, 36(1): 1-4. DOI: 10.3969/j.issn.1000-8179.2009.01.001
引用本文: 李瑞珍, 乌兰娜, 刘植华①, 王 倩②, 李俊华①, 李 晴①, 李 霓③, 刘志红, 石菊芳③, 张长淮, 周艳秋, 刘 彬③, 翁雷明, 吴瑞芳, 乔友林③. 4 种不同检查方法在宫颈癌筛查中的临床应用价值*[J]. 中国肿瘤临床, 2009, 36(1): 1-4. DOI: 10.3969/j.issn.1000-8179.2009.01.001
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LI Ruizhen, WULAN Na, LIU Zhihua, WANG Qian, LI Junhua, LI Qing, LI Ni, LIU Zhihong, SHI Jufang, ZHANG Changhuai, ZHOU Yanqiu, LIU Bin, WENG Leiming, WU Ruifang, QIAO Youlin. Clinical Application of Four Approaches in Cervical Cancer Screening[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2009, 36(1): 1-4. DOI: 10.3969/j.issn.1000-8179.2009.01.001
Citation: LI Ruizhen, WULAN Na, LIU Zhihua, WANG Qian, LI Junhua, LI Qing, LI Ni, LIU Zhihong, SHI Jufang, ZHANG Changhuai, ZHOU Yanqiu, LIU Bin, WENG Leiming, WU Ruifang, QIAO Youlin. Clinical Application of Four Approaches in Cervical Cancer Screening[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2009, 36(1): 1-4. DOI: 10.3969/j.issn.1000-8179.2009.01.001
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4 种不同检查方法在宫颈癌筛查中的临床应用价值*

Clinical Application of Four Approaches in Cervical Cancer Screening

    摘要
  • 摘要: 目的：了解4 种不同检查方法在宫颈癌筛查中的临床应用价值。方法：采用第二代杂交捕获技术（hybrid capture 2，HC-II）检测13种高危型人乳头瘤病毒（human papillomavirus ，HPV ）、薄层液基细胞学技术（Liquid-based cytology test，LCT ）检测宫颈脱落细胞、醋酸肉眼检查（visual inspection with acetic acid，VIA）和阴道镜检查4 种方法对2004年11月～2004年12月深圳南山区华侨城区域15～59岁有性生活女性共1 137 例进行盲法同步宫颈癌筛查。对阴道镜检查异常或可疑异常者行阴道镜下直接活检；对HPV 阳性并且LCT ≥未明确诊断意义的不典型鳞状上皮细胞（atypical squamous cells of undetetemined sign，ASCUS ），或HPV 阴性但LCT ≥低度鳞状上皮内病变（low grade squamous intraepithelial lesion ，LSIL ）的妇女再次行阴道镜下活组织病理学检查，以病理结果作为验证4种检查方法的金标准。结果：共取病理122 例。病理结果证实该人群中无宫颈癌病例：子宫颈上皮内瘤变（cervical intraepithelial neoplasia ，CIN）Ⅲ级3 例，CIN Ⅱ级11例，CIN Ⅰ级36例；慢性宫颈炎和鳞状上皮化生69例；正常宫颈3 例。人群的高危HPV 总检出率为14.0% ；LCT 阳性率为12.6% ；VIA 阳性率为12.5% ；阴道镜阳性率为13.6% 。随宫颈病变级别升高，高危HPV 感染率及LCT 阳性率均呈趋势性增加（P<0.005）；VIA 和阴道镜阳性率在各级宫颈病变中无统计学差异，但在宫颈病变组阳性检出率明显高于正常宫颈组。高危HPV 对宫颈高度病变的敏感性、特异性、准确性、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为100% 、87.1% 、87.3% 、8.8% 、100% 、7.6% 和0；LCT 以上各指标分别为92.9% 、88.4% 、88.5% 、9.1% 、99.9% 、8.0% 和8.0% ；VIA 以上各指标分别为35.7% 、96.0% 、95.3% 、10.0% 、99.2% 、8.9% 和67.0% ；阴道镜以上各指标分别为50.0% 、86.8% 、86.4% 、4.5% 、99.3% 、3.8% 和58.0% 。结论：高危HPV 检测和LCT 检查均为目前宫颈癌筛查较好的方法，VIA 和阴道镜检查敏感性较差，漏诊率高，不适合大范围筛查，但二者阴性预测值均较高，可应用于临床病例诊断。

     

    Abstract: Objective:To evaluate the clinical application of four approaches to cervical cancer screening. Methods: A total of 1,137 women of15to 59years old selected from Huaqiaocheng community, Nanshan district of Shenzhen received a population-based cervical cancer screening between November 2004and December 2004. All of the subjects were investigated by four approaches, including visual inspection with acetic acid (VIA), col-poscopy, hybrid captureⅡ(HC-Ⅱ) human papillomavirus (HPV) test and liquid-based cytology test (LCT). Subjects with abnormal or suspicious findings during colposcopy received biopsies. HPV-positive subjects with atypical squamous cells of undetermined sign (ASCUS) based on LCT or HPV-negative patients with low grade squamous intraepithelial lesion (LSIL) based on LCT had biopsies during colposcopy. The pathology results were used as gold standards to evaluate the four approaches for screening for cervical cancer. Results:A total of 122 biopsy specimens were obtained. Pathological examination found no cases of cervical cancer, 3 cases of grade Ⅲcervical intraepithelial neoplasia (CIN), 11cases of grade ⅡCIN, 36cases of grade ⅠCIN, 69cases of chronic cervicitis and metaplasia of squamous epithelium, and3 cases of normal cervix. The HPV-positive rate was 14.0% by HC-II, the LCT-positive rate was 12.6%, the VIA-positive rate was12.5%, and the colposcopy positive rate was13.6%. The HPV-positive rate and LCT positive rate increased as the pathological grade of cervical lesions increased ( P<0.005 ). The sensitivity, specificity, accuracy, positive prevalue, negative prevalue, positive likelihood ratio and negative likelihood ratio were 100 %,87.1%,87.3%,8.8%,100 %,11.3 and 23.5% for HC-II HPV for detecting high grade cervical lesions; 92.9%,88.4%,88.5%,9.1%,99.9%,8.0 and 8.0% for LCT; 35.7%,96.0%,95.3%,10.0%, 99.2%,8.9, and 67.0% for VIA; and 50%, 86.8%, 86.4%, 4.5%, 99.3%,3.8, and 57.6% for colposcopy.Conclusion: HC- Ⅱhigh risk HPV detection and LCT are presently two promising approaches for cervical cancer screening. The sensitivity of VIA and colposcopy is lower for detecting high grade cervical lesions and is therefore not suitable for screening, but their specificity and negative prevalue are higher and readily applicable for clinical testing.

     

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