论文部分内容阅读
目的评价液基细胞学检查(liquid-based cytology test,LCT)与高危型人乳头瘤病毒(human papillomavirus,HPV)检查2种方法不同组合方案在宫颈高级别病变(≥CIN2)筛查中的价值。方法采用LCT和高危型HPV检测2种方法对5 727例妇女进行检查,对1或2项结果异常者及阴道镜检查可疑异常者进行宫颈活检,以病理结果为金标准,比较各项诊断试验的评价指标,评估2种方法及其不同组合方案在宫颈≥CIN2病变筛查中的价值。结果 LCT阳性率(≥ASC-US)为10.8%,HPV阳性率为22.9%。LCT对≥CIN2病变的筛查敏感度低于HPV检测(86.7%比92.3%,P<0.05),特异度和诊断准确率(74.7%和76.2%)均高于HPV检测(69.8%和72.6%,P<0.05)。与单一方法比,LCT+HPV(任一阳性)方案的敏感度(98.7%)和阴性预测值(99.7%)显著提高,但特异度(60.8%)和准确率(65.4%)均下降(P<0.05);LCT+HPV(两项均阳性)方案的敏感度最低(80.7%),特异度和准确率最高(83.5%和83.1%),P<0.05;4种筛查方案对诊断≥CIN2病变的受试者工作(receiver operating characteristic,ROC)曲线下面积分别为:0.807、0.810、0.797、0.820。Z检验显示各方案的筛查效率差异无统计学意义(P>0.05)。结论 LCT和高危HPV检测均是宫颈高级别病变筛查的有效方法,联合筛查不能提高筛查效率,但LCT+HPV(任一阳性)方案能显著地提高筛查敏感度和阴性预测值,更具有成本-效益价值。
Objective To evaluate the value of two different combinations of liquid-based cytology test (LCT) and high-risk human papillomavirus (HPV) screening in the screening of high-grade cervical lesions (≥CIN2) . Methods 5 727 women were examined by LCT and high-risk HPV test. Cervical biopsy was performed on 1 or 2 patients with abnormal results and those with colposcopy suspicious abnormalities. The pathological results were taken as the gold standard. The diagnostic tests Of the evaluation indicators to evaluate the two methods and their different combinations of cervical ≥CIN2 lesions in the screening value. Results LCT positive rate (≥ASC-US) was 10.8%, HPV positive rate was 22.9%. The sensitivity of LCT to HPV ≥2 was lower than that of HPV (86.7% vs 92.3%, P <0.05), and the specificity and diagnostic accuracy (74.7% vs 76.2%) were higher than those by HPV (69.8% vs 72.6% , P <0.05). Sensitivity (98.7%) and negative predictive value (99.7%) of LCT + HPV (all positive) were significantly higher than those of LCT + HPV (P <0.05), but the specificity (60.8%) and accuracy <0.05). The LCT + HPV (both positive) programs had the lowest sensitivity (80.7%), the highest specificity and accuracy (83.5% and 83.1%), P < The area under the curve of receiver operating characteristic (ROC) was 0.807,0.810,0.797,0.820 respectively. Z test showed no significant difference in the screening efficiency of each program (P> 0.05). Conclusion Both LCT and high-risk HPV detection are effective methods for screening high-grade cervical lesions. Combined screening can not improve the screening efficiency, but LCT + HPV (either positive) can significantly improve screening sensitivity and negative predictive value, More cost - benefit value.