Objective To investigate the screening value of cervical fluid-based cytology test (TCT), high-risk human papillomavirus (HR-HPV) test, and colposcopy for cervical intraepithelial neoplasia (CIN) and cervical cancer in high-risk populations.
Methods A total of 466 patients between January 2013 and January 2015 with a history of intercourse bleeding were enrolled in this study, and the screening value of TCT, HR-HPV test and colposcopy for CIN and cervical cancer were retrospectively evaluated.
Results In the 466 patients, 165 were diagnosed with cervical inflammation, 116 with CIN, 182 with grade 2-3 CIN, and 3 with cervical cancer. The colposcopy had the highest sensitivity (84.1%), the lowest specificity (59.4%), high false positive rate (40.6%), low false negative rate (15.9%), and the highest negative predictive value (67.1%). The TCT had the highest specificity (84.8%) and the lowest false positive rate (15.2%). The indicators of HR-HPV were between those of TCT and colposcopy. There were significant differences in terms of these indicators among the three methods (P < 0.05). And the positive prediction value of HR-HPV was the highest (84.5%), while the negative prediction value of colposcopy was the highest (67.1%). There was a significant difference in the predictive value among the three methods (P < 0.05). The consistency of either TCT or HR-HPV alone with pathological diagnosis was poor (K=0.213, 0.343), while that of colposcopy was moderate (K=0.446). Combination of TCT and HR-HPV could significantly improve the diagnosis sensitivity (93.0%) with a lower false negative rate (7.0%); Youden index was 0.736, and the consistency with pathological examination was high (K=0.748).
Conclusions For high-risk population with a history of intercourse bleeding or other abnormal cervical disorders, the screening sensitivity of TCT and HR-HPV alone for CIN and cervical cancer is low with a high false negative rate. Colposcopy has a high sensitivity and a low specificity. By combination of TCT and HR-HPV, the validity, reliability and predictive values can be improved significantly, and the sensitivity is high with a low false negative rate and a high consistency with pathological examination.
Citation：
ZhouJing, LiZhengyu. The Value of Cervical Fluid-based Cytology Test, High-risk Human Papillomavirus Test, and Colposcopy in Screening Cervical Intraepithelial Neoplasia and Cervical Cancer in High-risk Populations. West China Medical Journal, 2016, 31(8): 1384-1388. doi: 10.7507/1002-0179.201600377
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Copyright © the editorial department of West China Medical Journal of West China Medical Publisher. All rights reserved
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- 1. 孟瑞琳, 马文军, 许燕君, 等.广东省妇女乳腺癌和宫颈癌筛查率及相关影响因素分析[J].华南预防医学, 2010, 36(2):8-10, 14.
- 2. 张敏鸽, 刘明晖.高危HPV与宫颈癌发生的相关性[J].实用癌症杂志, 2012, 27(6):670-672.
- 3. 龙腾飞, 代荫梅.宫颈病变筛查策略的效果分析[J].医学综述, 2011, 17(14):2154-2158.
- 4. 李玉林.病理学[M]. 7版.北京:人民卫生出版社, 2008:260-262.
- 5. 顾彩珑, 王玉萍, 党秋红, 等.薄层液基细胞学检测诊断宫颈癌及癌前病变的价值[J].中华实用诊断与治疗杂志, 2012, 26(9):890-892.
- 6. 王临虹, 邱琇, 郑睿敏, 等.我国宫颈癌流行病学状况及防治策略的回顾与展望[J].中国妇幼卫生杂志, 2010, 1(3):146-149.
- 7. 杨娟, 肖兰, 杨继洲.高危型HPV负载量与宫颈癌前病变发展的相关性[J].实用癌症杂志, 2012, 27(6):656-657.
- 8. Rey-Ares L, Ciapponi A, Pichon-Riviere A. Efficacy and safety of human papilloma virus vaccine in cervical cancer prevention:systematic review and meta-analysis[J]. Arch Argent Pediatr, 2012, 110(6):483-489.
- 9. Gage JC, Katki HA, Schiffman M, et al. The low risk of precancer after a screening result of human papillomavirus-negative/atypical squamous cells of undetermined significance papanicolaou and implications for clinical management[J]. Cancer Cytopathol, 2014, 122(11):842-850.
- 10. 高娜, 郑军, 石红, 等.高危型人乳头瘤病毒检测在宫颈病变筛查及诊断中的意义[J].中国医师进修杂志, 2012, 35(21):7-10.
- 11. 潘琪, 杨二姣, 韩大芬, 等. TCT联合HPV检测诊断宫颈病变的临床价值分析[J].现代生物医学进展, 2015, 15(1):80-83.
- 12. 朱俊美, 靳东芳, 白小英.不同方法诊断宫颈病变的价值探讨[J].现代中西医结合杂志, 2015, 24(2):163-165.
- 13. Jovanović AM, Dikic SD, Jovanovic V, et al. Correlation of human papilloma virus infection with cytology, colposcopy and histopathological examination of the bioptic tissue in low-and high-grade intraepithelial lesions[J]. Eur J Gynaecol Oncol, 2012, 33(5):512-516.
