宫颈病变筛查方法的临床评价

发布时间：2018-06-17 02:52

本文选题：乳头瘤病毒 + 液基薄层细胞学　；参考：《大连医科大学》2016年硕士论文

【摘要】：目的分析宫颈液基薄层细胞学检测(Thinprep cytologic test TCT)、DNA倍体定量分析和人乳头瘤病毒(human papilloma virus,HPV)检测及其联合检测在子宫颈病变筛查中的临床意义。方法采用大样本回顾性分析的研究方法,选取自2104-01至2015-10北京军区总医院妇产科门诊患者中自愿接受宫颈癌筛查者13313例,均行TCT、DNA倍体定量分析及HPV三项检测,其中对TCT异常(包括ASCUS及以上病变)和(或)DNA倍体定量分析异常(包括≥3个DNA倍体异常细胞、异倍体峰、异常细胞增生≥10%)和(或)HPV高危型阳性的患者均行阴道镜检查,其中留取子宫颈组织活检者358例,根据术后病理进行分析,分为正常或炎症、子宫颈上皮内瘤变Ⅰ级、子宫颈上皮内瘤变Ⅱ级、子宫颈上皮内瘤变Ⅲ级、宫颈癌,运用统计学方法χ2检验进行数据统计分析,对结果行ROC曲线即受试者工作特征(receiver operating characteristic)曲线下面积分析比较,面积在0.5～1.0之间为有意义,面积越大,诊断价值越高,根据统计结果分析比较找出宫颈癌的最佳筛查方案。结果以子宫颈组织活检病理学为诊断标准,358例患者中经活组织病理学诊断为正常或炎症者133例,占37.2%(133/358),宫颈癌或癌前病变者225例,占62.8%(225/358),其中子宫颈上皮内瘤变CIN I者101例,占28.2%(101/358),CINⅡ者 84 例,占 23.5%(84/358),CINⅢ者 36 例,占 10.0%(36/358),宫颈癌者 4 例,占 1.1%(4/358)。TCT、DNA、HPV 单项检查诊断宫颈癌及癌前病变的灵敏度分别为75.1%、83.1%、88.9%;特异度分别为78.9%、66.9%、61.7%;三者 ROC 曲线下面积分别为 0.642、0.727、0.735,均在0.5-1.0之间,有诊断价值;灵敏度比较,χ2=7.636,P0.05,差异有统计学意义;特异度比较χ2=8.192,P0.05,差异有统计学意义。三项检查四种联合TCT+HPV、TCT+DNA、DNA+HPV、TCT+DNA+HPV 检测宫颈癌前病变及宫颈癌的灵敏度分别为89.8%、85.3%、93.3%、95.1%,特异度分别为61.7%、60.9%、60.2%、60.9%,四种联合 ROC 曲线下面积分别为 0.871、0.726、0.954、0.962,均在0.5-1.0之间,有诊断价值,其中,灵敏度比较差异有统计学意义,χ2=7.255,P0.05;特异度比较差异无统计学意义,χ2=0.554,P0.05,AUC均在0.5-1.0之间,均有诊断价值。结论1、宫颈病变筛查方法中:TCT检测特异性高,但灵敏度低;HPV检测的灵敏度较高,但特异度较低,三者中DNA倍体定量分析检测的灵敏度优于TCT且特异度优于HPV;2、TCT+HPV联合检测优于单项TCT或HPV检测,但特异度低于TCT;TCT+DNA联合检测优于TCT或DNA,但特异度低于单项TCT;HPV+DNA联合检测优于单项HPV或DNA检测,但特异度低于TCT;TCT+HPV+DNA联合检测优于其他检测,灵敏度高,特异度优于其他检测,但低于单项TCT检测;四种联合检测AUC均在0.5-1.0之间,均有诊断价值,且TCT+HPV+DNA联合的AUC最大,最接近于1,诊断价值最高,其次为HPV+DNA。3、宫颈癌筛查首选TCT+DNA+HPV,其检出率高,漏诊率低,灵敏度高,特异度高,ROC曲线面积大,诊断价值高,推荐使用,但经济成本高;其次HPV+DNA联合检测灵敏度及特异度较高,诊断价值可接受,经济成本低,也可作为临床广泛推广的宫颈癌前病变的初步筛查手段。
[Abstract]:Objective to analyze the clinical significance of Thinprep cytologic test TCT (TLC test TCT), DNA ploidy quantitative analysis and human papillomavirus (human papilloma virus, HPV) detection and joint detection in the screening of cervical lesions. Methods a retrospective analysis of large samples was used to select Beijing army from 2104-01 to 2015-10. 13313 cases of cervical cancer screening were voluntarily accepted in the Department of Obstetrics and Gynecology of general hospital, all of which were TCT, DNA ploidy and three HPV, of which abnormal TCT abnormalities (including ASCUS and above lesions) and / or DNA ploidy (including more than 3 DNA ploidy cells, ISO ploidy, abnormal cell proliferation more than 10%) and (or) HPV high risk Type positive patients were examined by colposcopy, of which 358 cases of cervical biopsy were taken. According to the postoperative pathology, they were divided into normal or inflammation, cervical intraepithelial neoplasia grade I, cervical intraepithelial neoplasia grade II, cervix intraepithelial neoplasia grade III, cervical cancer, statistically analyzed by statistical method chi 2 test. Results the area analysis under the ROC curve (receiver operating characteristic) curve was compared. The area was between 0.5 and 1. The larger the area, the higher the diagnostic value. The best screening scheme for cervical cancer was found according to the statistical analysis. The result was the diagnosis of cervical biopsy pathology, 358 In the patients, 133 cases were diagnosed as normal or inflammatory, 37.2% (133/358), 225 cases of cervical cancer or precancerous lesions, accounting for 62.8% (225/358), 101 cases of CIN I in cervical intraepithelial neoplasia, 28.2% (101/358), 84 cases of CIN II, 23.5% (84/ 358), 36 cases of CIN III, 10% (36/358), and 4 cases of cervical cancer, 1.1% (4). /358) the sensitivity of.TCT, DNA, and HPV for the diagnosis of cervical cancer and precancerous lesions was 75.1%, 83.1%, 88.9%, respectively, and the specificity was 78.9%, 66.9%, 61.7%, respectively, and three were 0.642,0.727,0.735 under the ROC curve, respectively, between 0.5-1.0, and the diagnostic value; sensitivity comparison, Chi 2=7.636, P0.05, statistically significant; specificity comparison x 2=8.192, P0.05, the difference was statistically significant. The sensitivity of four combined TCT+HPV, TCT+DNA, DNA+HPV, TCT+DNA+HPV for cervical cancer and precancerous lesions and cervical cancer were 89.8%, 85.3%, 93.3%, 95.1% respectively, and the specificity was 61.7%, 60.9%, 60.2%, 60.9% respectively, and the area under the joint ROC curves was 0.871,0.726,0.954,0.962, respectively, at 0.5-1. Between.0, there was a diagnostic value, among which there was a significant difference in sensitivity, X 2=7.255, P0.05, and no difference in specificity, X 2=0.554, P0.05, AUC all had a diagnostic value between 0.5-1.0. Conclusion 1, the screening method of cervical lesions: TCT detection specificity is high, but the sensitivity is low, but the sensitivity of HPV detection is high, but specific, but specific, but specific, but specific The sensitivity of DNA ploidy quantitative analysis in the three is better than that of TCT and the specificity is better than that of HPV; 2, the joint detection of TCT+HPV is superior to single TCT or HPV detection, but the specificity is lower than TCT; TCT+DNA joint detection is superior to TCT or DNA, but the specificity is lower than single TCT; HPV+DNA joint testing is superior to single item or detection, but the specificity is lower than that; TCT+DNA +DNA combined detection is superior to other tests, with high sensitivity and better specificity than other tests, but lower than single TCT detection; four combined detection of AUC all have diagnostic value among 0.5-1.0, and TCT+HPV+DNA combined AUC is the largest, most close to 1, the diagnostic value is the highest, followed by HPV+DNA.3, cervical cancer screening is the first choice TCT+DNA+HPV, its detection rate is high, leakage rate is high Low diagnosis rate, high sensitivity, high specificity, high ROC curve area, high diagnostic value, high economic cost, high sensitivity and specificity of HPV+DNA combined detection, acceptable diagnostic value and low economic cost, can also be used as a preliminary screening method for cervical precancerous lesions widely popularized in clinic.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.33

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