An Assessment On Approaches Of Early Diagnosis Of Cervical Cancer

Cervical cancer is an important female health problem.Morbidity and mortality have declined significantly because of widely use of Papanicolaou smear(PAP) and screening while a rising and young tendency in some area with the increase of human papillomaviruses(HPV) infection.More than 100 HPV subtypes have been discovered which can be divided into high-risk HPV(HR-HPV) and low-risk HPV Many studies have shown HR-HPV infection is related to cervical cancer,it would not cause cancer unless cooperated with other synergistic factors such as smoking,multiple parity,long-term use of oral contraceptives,especially host immunity that plays a key role in the pathogenesis of cervical cancer.PAP has high false negative rate though successful in the clinical practice of screening.New techniques have been applied recently such as ThinPrep Pap and HPV DNA detection,etc.Colposcopy plays more and more important role in the diagnosis of early cervical cancer since the advent of electronic colposcope.Each technique has its own advantages and shortcomings which can be made up by combined application.TCT(or PAP),Colposcopy and HPV-DNA detection were combined for early diagnosis of cervical cancer in the present study.Objective:To compare the diagnostic value of PAP or TCT,Colposcopy and HPV-DNA detection on early diagnosis of cervical cancer separately and combined application.Methods:314 patients who received cytology test(PAP or TCT),HPV-DNA detection,Colposcopy and biopsy in clinics of Huanghe river hospital from August 2004 to June 2007 were enrolled.All cases had complete information including medical history, cytology test(PAP or TCT),HPV-DNA detection,Colposcopy and biopsy without acute vaginitis,hysterectomy,cervical operation or pregnancy.Clinical information were recorded and analyzed.The sensitivity,specificity,positive predictive value and negative predictive value of every detection method were compared to evaluate the detection efficiency.The histological diagnosis result was regarded as a "gold standard".The difference significance was assessed with the Chisquare test P＜0.05Results:1.Sensitivity:TCT(93.22%)＞COLP(82.88%)＞HRHPV(81.72%)＞PAP(64.71), TCT,COLP and HRHPV are significantly more sensitive than PAP(P＜0.05 ).2.Specificity:TCT(86.78%),PAP(86%),HRHPV(83.26%),COLP(77.83%),there is no significant difference among the 4 methods(P＞0.05 ).3.Sensitivity and negative predictive value of the combined use of PAP or TCT,COLP and HRHPV testing are higher than those of each method alone(P＜0.05).Conclusions:1.Sensitivity of TCT is higher than PAP without difference in specificity.2.PAP has low sensitivity and negative predictive value that can be raise when combing Colposcopy and HPV-DNA detection3.Biopsy directed by Colposcopy is one important diagnostic method of CIN.Combination of Colposcopy,cytology and HPV-DNA detection would raise negative predictive value to avoid unnecessary biopsy.4.The sencitivity of HPV-DNA test is higher than traditional cytology,however,its specificity is lower,ie,higher psudo-positive rate exists,as the result of which,HPV test alone is not suggested to diagnose cervical cancer and pre-cancerr pathological changes. However,HPV test is a nonsubjective and simple way to give first scieve about cervical cancer,because of which,it has a bright prospect.