HPV感染与TCT和DNA倍体分析在绝经前后宫颈癌筛查中的分析
|
摘要
目的探讨人乳头瘤病毒(Human papillomavirus,HPV)感染、液基细胞学技术(Thinprep cytologic test,TCT)及DNA倍体分析在绝经与未绝经妇女宫颈癌筛查中的临床效果,总结绝经妇女宫颈病变特点。方法收集2015年10月-2018年10月于医院行HPV检测、TCT检查及DNA倍体分析的女性患者为研究对象,包括HPV检测31 557例、TCT检查21 758例和DNA倍体分析7 695例,针对某项检测为阳性的患者,实施颈管多点活检,比较绝经妇女与未绝经妇女的差异。结果 HPV阳性率为18.72%(5 908/31 557),绝经与未绝经妇女HPV感染率差异无统计学意义(P=0.068)。TCT阳性率为6.13%(1 334/21 758),绝经妇女LSIL(低级别鳞状上皮内病变)、SCC(鳞癌)及ACC(腺癌)液基细胞学检出率分别为18.65%(83/445)、0.90%(4/445)及0.67%(3/445)与未绝经妇女比较差异有统计学意义(P<0.05)。DNA倍体分析阳性率为17.10%(1 316/7 695),绝经与未绝经妇女DNA倍体分析比较差异无统计学意义(P=0.069)。绝经妇女,TCT、DNA倍体分析、HPV检出宫颈病变的灵敏度分别为52.26%、75.86%、86.84%,特异度分别为66.67%、61.76%、33.33%;未绝经妇女,TCT、DNA倍体分析、HPV检出宫颈病变的灵敏度分别为62.07%、73.66%、86.75%,特异度分别为72.52%、55.56%、35.88%。结论绝经妇女患宫颈癌的风险更高,HPV检测敏感度高,可作为绝经后妇女宫颈癌筛查的初级筛查手段。
OBJECTIVE To compare the clinical effect of HPV infection, Liquid-based cytology and DNA ploidy analysis in cervical cancer screening between postmenopausal and premenopausal women. The features of cervical lesions in postmenopausal women were summarized and analyzed. METHOD A total of 31 557 cases of HPV, 21 758 cases of TCT and 7 695 cases of DNA ploidy analysis were collected from Oct. 2015 to Oct. 2018. Cervical multipoint biopsy was performed for patients with positive detection result to compare the difference between postmenopausal and premenopausal women. RESULTS The positive rate of HPV was 18.72%(5 908/31 557). Premenopausal and postmenopausal women had equal HPV infection rates(P=0.068). The positive rate of TCT was 6.13%(1 334/21 758). The positive rates of LSIL, SCC and ACC in postmenopausal women were 18.65%(83/445), 0.9%(4/445) and 0.67%(3/445) respectively, which were significantly different from those in premenopausal women(P<0.05). The positive rate of DNA ploidy analysis was 17.10%(1 316/7 695). There was no significant difference in DNA ploidy analysis between postmenopausal and premenopausal women(P=0.069). In postmenopausal women, the sensitivity of TCT,DNA ploidy analysis and HPV testing in detecting cervical lesions was 52.26%, 75.86%, 86.84%, and the specificity was 66.67%, 61.76%, 33.33% respectively. In premenopausal women, the sensitivity of TCT, DNA ploidy analysis and HPV testing in detecting cervical lesions was 62.07%, 73.66%, 86.75%, and the specificity was 72.52%, 55.56% and 35.88%, respectively. CONCLUSION Postmenopausal women have an increased risk of cervical cancer. HPV DNA testing as a primary screening modality has the highest sensitivity in postmenopausal women.
OBJECTIVE To compare the clinical effect of HPV infection, Liquid-based cytology and DNA ploidy analysis in cervical cancer screening between postmenopausal and premenopausal women. The features of cervical lesions in postmenopausal women were summarized and analyzed. METHOD A total of 31 557 cases of HPV, 21 758 cases of TCT and 7 695 cases of DNA ploidy analysis were collected from Oct. 2015 to Oct. 2018. Cervical multipoint biopsy was performed for patients with positive detection result to compare the difference between postmenopausal and premenopausal women. RESULTS The positive rate of HPV was 18.72%(5 908/31 557). Premenopausal and postmenopausal women had equal HPV infection rates(P=0.068). The positive rate of TCT was 6.13%(1 334/21 758). The positive rates of LSIL, SCC and ACC in postmenopausal women were 18.65%(83/445), 0.9%(4/445) and 0.67%(3/445) respectively, which were significantly different from those in premenopausal women(P<0.05). The positive rate of DNA ploidy analysis was 17.10%(1 316/7 695). There was no significant difference in DNA ploidy analysis between postmenopausal and premenopausal women(P=0.069). In postmenopausal women, the sensitivity of TCT,DNA ploidy analysis and HPV testing in detecting cervical lesions was 52.26%, 75.86%, 86.84%, and the specificity was 66.67%, 61.76%, 33.33% respectively. In premenopausal women, the sensitivity of TCT, DNA ploidy analysis and HPV testing in detecting cervical lesions was 62.07%, 73.66%, 86.75%, and the specificity was 72.52%, 55.56% and 35.88%, respectively. CONCLUSION Postmenopausal women have an increased risk of cervical cancer. HPV DNA testing as a primary screening modality has the highest sensitivity in postmenopausal women.
引文
[1] Chen W,Zheng R,Baade PD,et al.Cancer ststistics in China,2015[J].Ca Cancer J Clin,2016,66(2):115-132.
[2] 张霄,管晓静,李建琼,等.绝经后妇女子宫颈鳞状上皮内病变的临床分析[J].中华妇产科杂志,2018,53(10):705.
[3] Elit L.Role of cervical screening in older women[J].Maturitas,2014,79(4):413-420.
[4] 魏丽惠,赵超.宫颈癌及其癌前病变的筛查研究进展[J].中华妇幼临床医学杂志(电子版),2016,12(1):16.
[5] Muangto T,Chanthasenanont A,Lertvutivivat S,et al.Experience of combined liquid based cervical cytology and high-risk HPV mRNA for cervical cancer screening in Thammasat university hospital[J].Asian Pac J Cancer Prev,2016,17(9):4409-4413.
[6] 徐舜,陈洁瑛,江海燕,等.宫颈癌前病变HPV感染与宫颈液基细胞早期筛查的临床分析[J].中华医院感染学杂志,2017,27(20):4739-4742.
[7] Garner D.Clinical application of DNA ploidy to cervical cancer screening:A review[J].World J Clin Oncol,2014,5(5):931-965.
[8] Wentzensen N.Epidemiology,prevention and early detection of cervical cancer[J].Onkologe (Berl),2016,22(10):725-736.
[9] Kamineni A,Weinmann S,Shy KK,et al.Efficacy of screening in preventing cervical cancer among older women[J].Cancer Causes Contr,2013,24(9):1653-1660.
[10] 谢幸.妇产科学(第8版)[M].北京:人民卫生出版社,2013:301-304.
[11] Nayar R,Wilbur DC.The Bethesda system for reporting cervical cytology[M].Definitions,Criteria,and Explanatory Notes.Springer,2015.
[12] 孙振球.医学统计学(第3版)[M].北京:人民卫生出版社,2002:568-574.
[13] Bray F,Ferlay J,Soerjomataram I,et al.Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2018,68(6):394-424.
[14] Wang CJ,Palefsky JM.Human papillomavirus (HPV) infections and the importance of HPV vaccination[J].Curr Epidemiol Rep,2015,2(2):101-109.
[15] 赵海燕.绝经后妇女宫颈高危HPV感染及宫颈病变的临床分析[D].吉林大学,2017.
[16] Rebecca L,Alejandra C,Nick D,et al.Cervical cytology and the diagnosis of cervical cancer in older women[J].J Med Screen,2015,22(4):207-212.
[17] Holt HK,Zhang L,Zhao FH,et al.Evaluation of multiple primary and combination screening strategies in postmenopausal women for detection of cervical cancer in China[J].Int J Cancer,2017,140(3):544-554.
[18] Castanon A,Landy R,Cuzick J,et al.Cervical screening at age 50-64 years and the risk of cervical cancer at age 65 years and older:population-based case control study[J].PLoS Med,2014,11(1):e1001585.
[19] 邹冰玉,浦海鹰,李丹,等.210例高危型人乳头瘤病毒感染检测及宫颈病变影响因素的探讨[J].实用妇产科杂志,2013,29(12):938-940.
[20] Rustagi AS,Kamineni A,Weinmann S,et al.Cervical screening and cervical cancer death among older women:a population-based,case-control study[J].Am J Epidemiol,2014,179(9):1107-1114.
[21] 张雪梅,覃福宁,孙奇.宫颈DNA倍体分析及TCT在宫颈病变早期筛查中的临床意义[J].重庆医学,2016,45(14):1974-1976.
[22] 张峻霄,胡春艳,刘晨,等.DNA倍体分析技术在宫颈癌早期筛查中的应用价值[J].中国妇幼保健,2017,32(17):4121-4125.
[23] Arbyn M,Roelens J,Simoens C,et al.Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions[J].Cochrane Database Syst Rev,2013,28(3):CD008054.
[24] Ronco G,Giorgi Rossi P,Giubilato P,et al.A first survey of HPV-based screening in routine cervical cancer screening in Italy[J].Epidemiol Prev,2015,39(3 Suppl 1):77-83.
[25] Tifaoui N,Maudelonde T,Combecal J,et al.High-risk HPV detection and associated cervical lesions in a population of French menopausal women[J].J Clin Virol,2018,108:12-18.
[26] Arbyn M,Roelens J,Simoens C,et al.Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions.[J].Cochrane Database Syst Rev,2013,3(3):CD008054.
[27] Rizzo AE,Sarah F.Update on primary HPV screening for cervical cancer prevention[J].Curr Prob Cancer,2018:S0147027218301727.
[2] 张霄,管晓静,李建琼,等.绝经后妇女子宫颈鳞状上皮内病变的临床分析[J].中华妇产科杂志,2018,53(10):705.
[3] Elit L.Role of cervical screening in older women[J].Maturitas,2014,79(4):413-420.
[4] 魏丽惠,赵超.宫颈癌及其癌前病变的筛查研究进展[J].中华妇幼临床医学杂志(电子版),2016,12(1):16.
[5] Muangto T,Chanthasenanont A,Lertvutivivat S,et al.Experience of combined liquid based cervical cytology and high-risk HPV mRNA for cervical cancer screening in Thammasat university hospital[J].Asian Pac J Cancer Prev,2016,17(9):4409-4413.
[6] 徐舜,陈洁瑛,江海燕,等.宫颈癌前病变HPV感染与宫颈液基细胞早期筛查的临床分析[J].中华医院感染学杂志,2017,27(20):4739-4742.
[7] Garner D.Clinical application of DNA ploidy to cervical cancer screening:A review[J].World J Clin Oncol,2014,5(5):931-965.
[8] Wentzensen N.Epidemiology,prevention and early detection of cervical cancer[J].Onkologe (Berl),2016,22(10):725-736.
[9] Kamineni A,Weinmann S,Shy KK,et al.Efficacy of screening in preventing cervical cancer among older women[J].Cancer Causes Contr,2013,24(9):1653-1660.
[10] 谢幸.妇产科学(第8版)[M].北京:人民卫生出版社,2013:301-304.
[11] Nayar R,Wilbur DC.The Bethesda system for reporting cervical cytology[M].Definitions,Criteria,and Explanatory Notes.Springer,2015.
[12] 孙振球.医学统计学(第3版)[M].北京:人民卫生出版社,2002:568-574.
[13] Bray F,Ferlay J,Soerjomataram I,et al.Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2018,68(6):394-424.
[14] Wang CJ,Palefsky JM.Human papillomavirus (HPV) infections and the importance of HPV vaccination[J].Curr Epidemiol Rep,2015,2(2):101-109.
[15] 赵海燕.绝经后妇女宫颈高危HPV感染及宫颈病变的临床分析[D].吉林大学,2017.
[16] Rebecca L,Alejandra C,Nick D,et al.Cervical cytology and the diagnosis of cervical cancer in older women[J].J Med Screen,2015,22(4):207-212.
[17] Holt HK,Zhang L,Zhao FH,et al.Evaluation of multiple primary and combination screening strategies in postmenopausal women for detection of cervical cancer in China[J].Int J Cancer,2017,140(3):544-554.
[18] Castanon A,Landy R,Cuzick J,et al.Cervical screening at age 50-64 years and the risk of cervical cancer at age 65 years and older:population-based case control study[J].PLoS Med,2014,11(1):e1001585.
[19] 邹冰玉,浦海鹰,李丹,等.210例高危型人乳头瘤病毒感染检测及宫颈病变影响因素的探讨[J].实用妇产科杂志,2013,29(12):938-940.
[20] Rustagi AS,Kamineni A,Weinmann S,et al.Cervical screening and cervical cancer death among older women:a population-based,case-control study[J].Am J Epidemiol,2014,179(9):1107-1114.
[21] 张雪梅,覃福宁,孙奇.宫颈DNA倍体分析及TCT在宫颈病变早期筛查中的临床意义[J].重庆医学,2016,45(14):1974-1976.
[22] 张峻霄,胡春艳,刘晨,等.DNA倍体分析技术在宫颈癌早期筛查中的应用价值[J].中国妇幼保健,2017,32(17):4121-4125.
[23] Arbyn M,Roelens J,Simoens C,et al.Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions[J].Cochrane Database Syst Rev,2013,28(3):CD008054.
[24] Ronco G,Giorgi Rossi P,Giubilato P,et al.A first survey of HPV-based screening in routine cervical cancer screening in Italy[J].Epidemiol Prev,2015,39(3 Suppl 1):77-83.
[25] Tifaoui N,Maudelonde T,Combecal J,et al.High-risk HPV detection and associated cervical lesions in a population of French menopausal women[J].J Clin Virol,2018,108:12-18.
[26] Arbyn M,Roelens J,Simoens C,et al.Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions.[J].Cochrane Database Syst Rev,2013,3(3):CD008054.
[27] Rizzo AE,Sarah F.Update on primary HPV screening for cervical cancer prevention[J].Curr Prob Cancer,2018:S0147027218301727.