| Background and ObjectiveCervical cancer is the fourth most common cancer,ranking seventh among women worldwide,and 85%of cervical cancers occur in developing countries.Worldwide,cervical cancer has a high incidence in the 30-40 age group,and the disease has a double peak after 70 years of age,that is,both morbidity and mortality have increased.The number of new cases in China each year is 131,500,and the number of cervical cancer deaths is about 53,000,accounting for 18.4%of all female cancer deaths.As in the world,the incidence and mortality of cervical cancer in developed regions are lower than in less developed regions.During the progression of cervical lesions,early screening and early intervention for cervical lesions are necessary means to prevent and control cervical cancer and reduce the incidence and mortality of cervical cancer.As a secondary prevention of cervical cancer,the importance of screening is self-evident.With our deeper understanding of the development of cervical lesions,more and more screening methods have emerged.P16INK4a(P16)is a tumor suppressor protein.p16 can bind to CDK4 and CDK6 and play an important role in the regulation of the cell cycle.In HPV infected cells,as described above,the E7 protein competes for binding to the cell cycle regulator protein pRb.Through negative feedback regulation,E7 is interference with the pRb-E2F1 pathway leads to p16 overexpression and accumulation in the cell.Related studies have shown that P16 immunohistochemistry can significantly improve the repeatability and accuracy of histopathological diagnosis.Compared with.Pap smears,p16INK4a cytology is more sensitive to the detection of cervical lesions.In order to seek to verify a better screening method and solve the problems faced by screening at this stage,In this study,different clinical screening methods:cytological P16 detection,HPV,and TCT were compared to compare the relevant testing efficacy,and the cytological P16 detection,HPV,and TCT were used in combination for screening.It is used to comprehensively analyze and evaluate the advantages and disadvantages of cytology p16 and P16 combined with TCT/HPV,and provide new ideas for clinical cervical cancer screening and shunting.Materials and methods200 patients from the second affiliated hospital of Zhengzhou University from 2018.06 to 2019.03 who planned to undergo colposcopy were taken out of the cervix,and cervical exfoliated cells were taken for P16INK4a test,TCT,HPV-DNA test The preparation of stains for cervical cytology P16INK4a detection relies on the PathCIN p16 automatic immunohistochemical staining machine of Shenzhen Senying Biotechnology Co.,Ltd.All cases underwent colposcopy pathological tissue biopsy.The pathological results were used as the gold standard.The different expressions of cervical cytology P161NK4a detection,TCT,HPV-DNA detection in different pathological minutes were analyzed,and separate detection and cervical cytology P16INK4a detection were calculated.The sensitivity,specificity,positive predictive value,negative predictive value,and Yoden index of the LSIL+test were tested in combination with TCT and HPV-DNA tests,and the area under the ROC curve of P16INK4a test for cervical cytology was calculated.SPSS22.0 statistical software was used for statistical analysis,and P<0.05 was defined as a statistically significant difference.Results1.Of the 200 samples,46 were p16 positive(23%)and 154 were negative(77%).Among the 46 positive samples,14 were normal/cervicitis(30.4%),28 were LSIL(60.9%),and 4 were HSIL(8.7%).X2=46.957,p<0.001,the difference was statistically significant.In this study,the positive pathological results were defined as LSIL+,that is,those with pathological results of LSIL or HSIL were positive.There were 56 positive results,accounting for 28%of all pathological results.The positive predictive value and the negative predictive value of LSIL+were:P16:69.57%and 84.21%;HPV:28.74%and 75.00%;TCT:44.74%and 81.97%.The predicted sensitivity and specificity are:P16:57.14%,90.14%;HPV:89.29%,12.68%;TCT:60.71%,70.42%.For the detection of LISL+,the area under the ROC curve detected by cytology P16 protein was 0.732,which was larger than the area under the ROC curve detected by HPV 0.525.2.P 16,HPV,and TCT were screened in pairs,of which HPV DNA+TCT had the highest sensitivity(60.71%),and P16+HPV and P16+TCT combined screening had the highest specificity(both 90.14%).3.The positive predictive value and negative predictive value of P16+HPV were the highest(69.57%;84.21%).The Jordan index of the three combined screening tests are:HPV+TCT:0.3114;HPV+P16:0.4728;TCT+P16:0.4728.The Jordan method of cytology P16 participating in the two methods is the same and both are higher than HPV+TCT.Conclusions1.As a screening for cervical lesions,HPV testing has advantages such as simple operation,low cost,and high sensitivity.And TCT+HPV combined screening,as a supplement to individual HPV screening,effectively improves its specificity of detection,and is currently recognized as an effective cervical cancer screening program.2.As a new detection method,cervical cytology p16INK4a test has higher test value.It has the characteristics of simple operation,clear staining,detailed reading standards,etc.,and can be further promoted and applied in clinical practice.3.Cervical cytology p16INK4a combined with HPV detection shows higher detection efficiency,and it is more simple and effective in clinical application.It should be used as a first-line screening program in clinical application. |
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