Clinical Value Of TCT Combined HPV-DNA Testing In Cervical Cancer And Precancer

[Objective]:To research the clinical value of Thin-layer liquid-based cytology combined HPV-DNA testing in cervical cancer and precancerous lesions.[Methods]:Application of shandong university affiliated provincial hospital digitization cases, read system continuously collect all the cases from April 2005 to June 2010 receiving treatment in gynecological ward first time for cervical tumor.With criteria, screening and doesn't accord with exclusion standard cases 248 patients for research object, record the patient's age, preoperative cervical cytology smear, living tissue pathology and postoperative pathologic diagnosis information and records including 74 cases HPV infection results on the HPV-DNA genotyped detection. Application of Microsoft excel 2007 to constitute database, and SPSS 16.0 to statistical analysis.[Results]1. Among 248 patients:9 cases of malignant lesions,and among the rest 239 cases 144(60.3%) is precancerous lesions,67(28.0%) is infiltrating squamous cell carcinoma,12(5.0%) is the micoinvasive cerical cancer,12(5%) is adenocarcinoma, and the other 4(1.7%) cases.2. The average age of 248 patients is 41.3 years old,median age is 40.5 years old, the average age of the patients with intraepithelial mild dysplasia and below was 39.4 years old, patients with severe dysplasia is 40.5 years,patients with carcinoma in situ is 39.7 years old, patients with microinvasive carcinoma is 39.4 years old, patients with infiltrating cervical cancer or more serious is 43.9 years old. A chi-square analysis the age composition of pre-cancerous and cervical cancer is significant (P< 0.05).3.248 patients sample research:TCT diagnosis carcinoma in situ and above of cervical lesions, the sensitivity is 64.1%, specificity is 46.3%. Among them the ASC-H tested carcinoma in situ and above is 75%, ASC-US tested carcinoma in situ and above is 47.8%, both final pathologic constitute has a statistical differences (P< 0.05). LSIL group for CINII+positive is 80.95% HSIL group for CINII+positive is 94.4%.4.74 patients sample research:HPV-DNA genotyped detection diagnosis carcinoma in situ and above of cervical lesions the sensitivity is 66%, the specificity is 75.0%(1) Different cytology results infection HPV situation is different, the infection rates of the normal and inflammation group, ASC-US group, ASC-H group, LSIL group, HSIL group respectively is 50%,50%,70%,53%,92%. The differences between the following four pairs:HSILgroup with the normal and inflammation group, ASC-US group and LSIL group, LSIL group and HSIL group, are statistically significant.(2) Different degree of cervical lesions have different situation of HPV infection:HPV infection rates of normal or inflammatory,CINâ… , CINâ…¡-â…¢, cervical cancer respectively, is 33.3%,77.8%,88.1%,90%.Among low-risk type HPV infection CINI and below accounts for 46.2%,CINâ…¡-â…¢accounts for 23.1%,cervical cancer accounts for 30.8%.Among high-risk type HPV infection CINI and below accounts for 4.0%,CINâ…¡-â…¢accounts for 68%,cervical cancer accounts for 28.0%.(3) In high-risk pattern HPV 16,18 and 31 is mostly common, respectively accounted for 54.0%,12,0%,12.0%; In low-risk pattern HPV 6,11 and 43 is mostly common, respectively accounted for 46.2%,23.1%,15.4%.Also found 2 cases double infection,1 case triple infection.5. ROC curves statistical analysis results(1) 248 patients, thin fluid cytology smear results and preoperative pathological comparison:diagnosis carcinoma in situ and above cervical lesions AUCcytoiogy =0.556 (P=0.135>0.05)<AUC preoperative pathological=0.878 (P<0.05). Diagnosis moderate intraepithelial neoplasia and above cervical lesions AUC cytology=0.677 (P=0.007< 0.05)< AUCpreoperative pathological=0724 (P=0.001 0.05).(2) 74 patients with TCT combined HPV-DNA testing and preoperative pathological comparison, the ROC curves of separate cytological examination, the HPV-DNA testing, cytology combined HPV-DNA test, preoperative biopsy becomes higher and higher, area under the curve, respectively, is 0.585 (P> 0, 05),0.687 (P<0.05),0.694 (P<0.05), conclusion (P<0.05).[Conclusion]1. Women with cervical cancer and pre-cancerous is younger and younger,each stage onset ages have the forward trend, so early detection and early treatment can reduce the morbidity and mortality of cervical cancer.2. Thin layer of liquid base cytology smear technology (TCT) in cervical cancer and pre-cancerous screening plays an important role in its higher sensitivity.3. At present, high-risk pattern HPV infection is the existence of the potential factors of cervical cancer happens, persistent HR-HPV infection adumbrative cervical lesions. HPV-DNA test combined cytology is more effective for cervical lesions screening.