| Objectives:Based on the data of cervical cancer screening in the Second Affiliated Hospital of Kunming Medical University in the past four years,the application value of cervical cytology,HC2 and HPV typing detection technology in cervical cancer screening was analyzed,in order to provide the basis for making a reasonable and effective comprehensive prevention and treatment plan for cervical cancer in the future.Methods:From January 2016 to December 2019,the clinical data of 60107 women who were screened for cervical cancer in the Second Affiliated Hospital of Kunming Medical University were collected.Among them,22129 were cytologically examined,10135 were HC2 detected and 27843 were HPV typing detected.Based on the results of histopathological diagnosis,the relationship between three screening methods and cervical cancer and precancerous lesions was discussed.SPSS 23.0 software was used to analyze the data.Logistic regression analysis was used to analyze the correlation between different HPV subtypes and the degree of cervical lesions.X2 test was used to compare the counting data,and P<0.05 was statistically significant.In addition,in the same period,379 women underwent cervical cytology and HC2 combined detection and had histopathological diagnosis results.The diagnostic value of cytology,HC2 and their combined screening methods for cervical cancer and precancerous lesions was compared.Results:1.Age distribution:in this study,60107 women were screened for cervical cancer,aged between 14 and 91 years old.Women under 21 years old were divided into one age group.Women between 21 and 65 years old were divided into 9 age groups with 5-year-old interval.Women over 65 years old were divided into one age group,totally 11 age groups.The results showed that:(1)among the 11 age groups,41-45 age group received the most cervical cancer screening,and 21-65 age group received more cervical cancer screening than the 21-65 age group Age group.(2)After comparing the abnormal rates of three primary screening methods in 11 age groups,it was found that there was no significant difference in the abnormal rates of each age group in the primary screening method of cervical cytology(P>0.05).but there was significant difference in the abnormal rates of each age group in the primary screening method of HC2 and HPV typing(P<0.05).Furthermore,the abnormal rates of different age groups in HC2 and HPV typing were compared.It was found that the abnormal rates of<21-year-old group in HC2 and HPV typing were significantly higher than that of most age groups(P<0.05).The abnormal rates of>65-year-old group were not significantly different from those of most age groups in the 21-65-year-old age range(P>0.05),while those of 21-65-year-old group were not significantly different(P>0.05)There was no significant difference in the abnormal rate of most age groups(P>0.05).(3)There were 1260 cases with histopathological diagnosis results among the three primary screening methods.Compared with the distribution of histopathological diagnosis results among 11 age groups of 1260 women,CIN was detected in all age groups,but there was no significant difference in the detection rate of CIN in all age groups(P>0.05);there was significant difference in the detection rate of invasive cancer in all age groups(P<0.0 5)The detection rate of invasive cancer in the age groups of 51-55 and 65 was significantly higher than that in the age groups of 21,21-25,26-30,31-35 and 41-45.2.Cytological examination results:there were 22129 women who received cervical cytological examination,625 women with abnormal results(?ASC).of which ASC,LSIL,HSIL and SCC accounted for 64.96%(406/625),31.52%(197/625),3.36%(21/625)and 0.16%(1/625)respectively.Among 625 cases with abnormal cytological results,210 cases had histopathological diagnosis,24 cases of 86 cases of LSIL had pathological diagnosis of CIN I,with an accuracy of 27.91%(24/86),22 cases of high diagnosis(pathological diagnosis of normal or inflammatory),40 cases of low diagnosis(pathological diagnosis of CIN ? or above).46.51%(40/86),8 cases of HSIL The accuracy rate of pathological diagnosis was 80.00%(8/10).2 cases(20.00%(2/10)with high diagnosis(normal or inflammatory or CIN I)had no low diagnosis(invasive cancer);1 case(100.00%(11)with SCC was invasive cancer.3.HC2 test results:in the data of this group,10135 women received HC2 test,1487 were abnormal(?1 RLU/CO),and the percentages of low load group(1-99.99rlu/CO),medium load group(100-999.99rlu/CO)and high load group(>1000 RLU/CO)were 67.05%(997/1487),22.46%(334/1487),10.49%(156/1487).338 of 1487 patients with abnormal HC2 were diagnosed by histopathology.The incidence of CIN I was 21.56%(36/167),24.54%(24/110)and 18.04%(11/61)in the low,medium and high load groups,respectively.There was no significant difference between the three groups(x2=0.399,P=0.63 1(P>0.05).The incidences of CIN ?/? lesions were 10.78%(18/167),29.09%(32/110)and 42.62%(26/61)in the low,medium and high load groups,respectively.The incidences of CIN ?/? lesions were different between the three groups(P<0.05).The incidences of CIN?/? lesions in the middle and high load groups were significantly higher than those in the low load group(P<0.05)There was no difference between the two groups(P>0.05).The incidence of invasive cervical cancer in the low,medium and high load groups was 6.59%(11/167),11.82%(13/110)and 14.75%(9/61),respectively,and there was no significant difference between the three groups(P>0.05).4.Results of HPV typing:there were 27843 women who received HPV typing test,2966 women who had abnormal hrHPV testing results,of which,the highest number of hrHPV subtypes were HPV16,638(18.42%),followed by HPV58,551(15.91%),hpv52,424(12.24%),HPV18,274(7.91%),hpv51,251(7.25%),hpv56,245 Cases(7.07%)and so on.Among 2966 cases with abnormal hrHPV test results,712 cases had histopathological diagnosis results.Among all subtypes of hrHPV,HPV 16,52 and 18 were the three subtypes of cervical invasive cancer.The subtypes with high probability of?CIN were HPV16(51.13%),52(46.36%),58(45.45%),56(44.64%),59(43.75%)and 31(42.11%).There was significant difference(P<0.05).The results showed that there was a significant correlation between HPV 16,hpv52 and HPV58 and CIN(P<0.05).5.Cytology combined with HC2 detection:there were 379 women who had cervical cytology and HC2 combined detection and histopathological diagnosis results in this group of data.Taking histopathological results as the gold standard,the lesions?CIN were defined as positive pathological results.The sensitivity of single cytology,single HC2 and their combined screening was 36.84%,81.20%and 83.46%,and the specificity was 90.24%,63.01%and 58.54%,respectively.The sensitivity of single cytology was significantly lower than that of single HC2 and combined screening(P<0.05),but the specificity of single HC2 was higher than that of single HC2 and combined screening(P<0.05),but the difference between single HC2 and combined screening was not significant(P>0.05).The area under ROC curve of the above three screening schemes is 0.622,0.700 and 0.668 respectively,and the results are all in the range of 0.5-1.0,which has diagnostic significance.The area under ROC curve of single HC2 detection is the largest,closest to 1,followed by joint screening,and the area under curve of single cytology examination is the smallest.Conclusions:1.This study shows that the detection rate of invasive cancer is higher in the age group>65 years old.It is suggested that cervical cancer screening should be carried out even if the age group is not within the age range of conventional screening.2.In this study,the higher the level of cervical cytology results,the higher the diagnostic accuracy of cervical lesions,the higher the diagnostic accuracy of HSIL and SCC,no missed cases.3.Compared with the low viral load group,the high and medium viral load groups are more likely to have CIN ?/? lesions,indicating that the high and medium viral load of HPV may have a higher clinical guidance value in diagnosing and predicting the development and prognosis of the disease.4.Among all subtypes of hrHPV in this study,HPV 16,52 and 18 are the three subtypes that cause cervical cancer.There is a significant correlation between HPV 16,52 and 58 subtypes and ? CIN lesions.Therefore,in the stratified management of HPV infected women,the follow-up of HPV 16,18,52 and 58 infected women should be strengthened.5.Compared with single cell primary screening and combined cell primary screening,single HC2 primary screening may be a more cost-effective and recommended primary screening scheme in our hospital. |
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