The Application Of TCT And HPV DNA Test In The Screening Of Cervical Lesion

ObjectiveTo investigate the value of TCT and HPV DNA test in the screening of cervical lesion.Methodsa total of530cases with abnormal cervical lesion, who were enrolled in the second hospital of Shanxi medical university from October2010to March2012, were examined for TCT, SPR-HPV genotyping testing and colposcopy with biopsy. Regard pathology detection results as golden standard, and based on the positive detection result of ASCUS or high-risk HPV. All inspection was agreed before checking by the patients. SPSS18.0software was selected for statistical data analysis of medical records.Results1. Of the normal or inflammation, ASCUS,LSIL. HSIL,and SCC cases with HPV detection rate were26.06%(117/449)、59.52%(25/42)、82.61%(19/23)、90.91%(10/11)、100%(5/5). The Cochran-Armitage trend test(χ2=71.672, P<0.001) shows that with the aggravation of TCT degree, the positive rate of high-risk HPV was significantly increased.Of the normal or inflammation, CIN Ⅰ,CIN Ⅱ-Ⅲ and SCC cases with HPV detection rate were19.69%(90/457)、78.67%%(59/75)、95.65%(22/23)、100%(5/5). The Cochran-Armitage trend test(χ2=146.855,P<0.001) shows that with the aggravation of pathology degree, the positive rate of high-risk HPV was significantly increased.2. Of the176cases HPV-positive,59cases positive with TCT had been detected, accounting for33.52%(59/176); Of the354cases HPV-negative,22cases positive with TCT had been detected, accounting for6.21%(22/354).The chi-square test (χ2=67.708, P<0.001) shows that TCT positive rate had significant difference among two groups, which had statistical significance.Of the176cases HPV-positive,86cases positive with pathology had been detected, accounting for48.86%(86/176); Of the354cases HPV-negative.17cases positive with pathology had been detected, accounting for4.80%(17/354).The chi-square test(χ2=145.761, P<0.001) shows that pathology positive rate had significant difference among two groups, which had statistical significance.3. Of the530cases,103pathology positive had been detected. Among of them, there were 46TCT-positive detection,86high-risk HPV-positive detection, and94joint-positive, with positive rate was44.66%(46/103),83.50(86/103),91.26(94/103).The McNemar test (χ2=46.021,P <0.001)shows that the positive rate had significant difference between TCT and the joint, which had statistical significance. The Exact Probabilities (P=0.008) shows that the positive rate had significant difference between high-risk HPV and the joint, which had statistical significance.4. Of TCT,the sensitivity was44.66%,the specificity was91.80%,the positive prediction value was56.79%,and the negative predictive value was87.31%; Of SPR-HPV, the sensitivity was83.50%,the specificity was78.92%,the positive predictive value was48.86%,and the negative prediction values was95.20%; The McNemar test (χ2=27.161, P<0.001)shows that the sensitivity had significant difference between TCT and SPR-HPV, which had statistical significance. The McNemar test(χ2=35.133, P<0.001)shows that the specificity had significant difference between TCT and SPR-HPV, which had statistical significance. The chi-square test(χ2=2.564, P=0.109)shows that the positive predictive value had no significant difference between TCT and SPR-HPV, which had no statistical significance. The chi-square test(χ2=24.302, P=0.109)shows that the negative predictive value had significant difference between TCT and SPR-HPV, which had statistical significance.Conclusion1. With the aggravation of TCT and pathology degree, the infection rate of high-risk HPV was significantly increased;2. HPV DNA test had clinical significance on early cervical lesion;3. TCT combined with HPV DNA test can increase the sensitivity of cervical lesion and reduce false negative rate;4. With higher sensitivity, negative predictive value and lower specificity of HPV DNA test, it is possible that HPV DNA test turned to be the first and cytology second in the future of cervical lesion screening.