| Objective:Liquid-based cytologic test, hybrid captureⅡ(HCⅡ), human papilloma virus (HPV) test and Colposcopy were used to diagnose and analyse the cervical lesions of women with different ages groups. By comparing the results with the pathological examination of biopsy taken directly under colposcopy, to evaluate the values of the three kinds of detection methods ( TCT,HCⅡand Colposcopy) and their joint detection in the early diagnosis of cervical lesions, and to investigate the clinical application values of the three kinds of detection methods and the joint detection in the screening of cervical lesions.Methods:Totally, 884 patients in the gynaecology and obstetrics departmend of Qilu hospital, from August 2009 to August 2010, were made early diagnosis by different kinds of detection methods. 334 cases in the research were made TCT test in three months before colposcopy and 405 cases were made HCⅡtest in one months before colposcopy. All the 884 case were tested by colposcopy and the bioposies were taken directly, while part of the cases were made endocervical curettage (ECC) test according to the results, simultaneously. The results of the different tests were compared with the pathological examination of biopsy for further analysis.Results:(1) 884 cases were selected in the study, with the manimum age was 77 year-old and the minimum age was 20 year-old, while the average age was 41.01±9.98 year-old. The results showed that 30-49 year-old age group was the high-risk age stage for cervical lesions. The pathological and histological examination of biopsy was set as the standards and all the results from other test were compared with them. The relevance ratio of cervical lesions much higher than ASCUS by TCT test was 83.33%, while the relevance ratio of higher cervical lesions by HCⅡtest and colposcopy test were 92.89% and 88.89%, respectively. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of cervical lesions by the joint detection of TCT and colposcopy test were 95.45%, 44.92%, 37.33% and 96.64%, respectively, while the omission diagnostic rate was 4.55%. For the joint detection of HCⅡand colposcopy test, the same parameters above were 94.23%,25.44%,36.57% and 90.63%, with the omission diagnostic rate was 4.55%. Joint detection could increase the detection rate and NPV of cervical lesions and decrease the omission diagnostic rate.(2) The results showed that 30-49 year-old was the highest trend age group for cervical infection with high-risk HPV and cervical precancerous lesions, with age growing, the infection rate of HR-HPV declined gradually. The total infection rate of HR-HPV in the age group was 66.91% (271/405), and the infection rate of chronic cervicitis, CINⅠ,CINⅡ, CINⅢ, cervical cancer were 52.94% (81/153), 60.18% (113), 88.14% (68/52/59), 89.83% (53/59), 88.24% (15/17), respectively. The infection rate of high cervical lesions was higher than 88.89% (120/135) and the infection rate of HR-HPV increased along with the increasing order of cervical lesions severity.(3) 6 months after cervical conization for cervical lesions, 33 cases were detected by HCⅡtest and the results showed that the negative conversion rate of HPV infection was 39.40% (13/33) and the HPV loading capacity reduced 84.85% (28 / 33). The average loading capacities of HPV before and after treatment were 835.17 + 951.43 and 257.72 + 666.66, respectively. The average loading capacity after treatment declined obviously comparing to that before treatment (P = 0.014).Conclusion:(1) Liquid base cervical cytological examination (LCT) was a good method with higher detection rate for early detection of higher cervical lesions. For the cases with positive result, further test such as high-risk type HPV-DNA and colposcopy test should be carried out. Biopsy taken directly under colposcopy and scraping of cervical canal in necessary could improve the diagnosis accuracy, while reducing the omission diagnose rate.(2) The infection rate of HR-HPV increased significantly along with the increase of cervical lesion severity; High-risk type HPV-DNA testing could be used as an important monitoring index for lower cervical lesions and follow-up for higher cervical lesions after treatment.(3) Colposcopy had an important role in screening of cervical lesions, RCI score could evaluate the image objectively and accurately, biopsy under colposcopy could reduce the omission diagnose rate and improve the diagnostic accuracy.(4) The cervical lesion screening of women older than 30 year-old should cause much attention, especially for the women with 30-49 year-old. Further normalizing the technique standards process of cervical lesions both in diagnosis and treatment could improve the diagnosis accuracy and reduce excessive treatment. |
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