摘要
目的探讨阴道镜阴性象限活检联合高危人乳头瘤病毒(HPV)E6/E7 mRNA检测对宫颈癌的诊断价值及其与病理检查诊断的一致性。方法选取2022年1月至2023年1月在该院进行子宫颈防癌筛查异常的115例女性患者作为研究对象,均进行阴道镜阴性象限活检及高危HPV E6/E7 mRNA检测,并且因病情需要进行宫颈锥切术。以宫颈锥切术病理检查作为“金标准”,分析两种诊断方式单独及联合检测对HSIL+[宫颈上皮内瘤变(CIN)Ⅱ级、CINⅢ级记为宫颈高级别病变(HSIL),HSIL及以上级别病变记为HSIL+]的诊断价值;比较不同宫颈病变级别患者阴道镜Reid评分、高危HPV E6/E7 mRNA表达水平;采用受试者工作特征(ROC)曲线分析二者对宫颈癌的诊断价值。结果115例女性患者组织病理检查结果显示,CINⅠ级患者26例,HSIL+患者89例。阴道镜阴性象限活检共检出CINⅠ级患者34例,HSIL+患者81例,与组织病理检查结果的Kappa值为0.644(P<0.05),诊断准确度为73.04%;高危HPV E6/E7 mRNA检测共检出CINⅠ级患者26例,HSIL+患者89例,与组织病理检查结果的Kappa值为0.453(P<0.05),诊断准确度为80.87%;阴道镜阴性象限活检、高危HPV E6/E7 mRNA联合检测共检出CINⅠ级患者40例,HSIL+患者75例,与组织病理检查结果的Kappa值为0.708(P<0.05),诊断准确度为87.83%。宫颈癌患者阴道镜Reid评分、高危HPV E6/E7 mRNA表达水平均高于HSIL患者和CINⅠ级患者,HSIL患者又高于CINⅠ级患者,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,阴道镜Reid评分、高危HPV E6/E7 mRNA表达水平联合检测诊断宫颈癌的曲线下面积为0.887,相对于二者单独诊断的效果更明显,重新分类指数为0.885(95%CI:0.351~1.205),改善指数为0.182(95%CI:0.024~0.317)。结论宫颈癌诊断中阴道镜阴性象限活检、高危HPV mRNA联合检测与组织病理检查结果有较高的一致性,对宫颈癌有一定的诊断价值。
Objective To investigate the diagnostic value of colposcopy-negative quadrant biopsy combined with high-risk human papillomavirus(HPV)E6/E7 mRNA detection in cervical cancer and its consistency with pathological diagnosis.Methods A total of 115 female patients with abnormal cervical cancer screening in the hospital from January 2022 to January 2023 were selected as the research objects.All of them underwent colposcopic negative quadrant biopsy and high-risk HPV E6/E7 mRNA detection,and cervical conization was needed because of their condition.Taking the pathological examination of cervical conization as the"gold standard",the diagnostic value of the two diagnostic methods alone and in combination for HSIL+[cervical intraepithelial neoplasia(CIN)gradeⅡand CINⅢwere defined as high-grade cervical lesion(HSIL),and HSIL or higher grade lesions were defined as HSIL+]was analyzed.The Reid score of colposcopy and the expression level of high-risk HPV E6/E7 mRNA in patients with different grades of cervical lesions were compared.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of the two indicators for cervical cancer.Results The pathological examination results of the 115 female patients showed that 26 cases of CINⅠand 89 cases of HSIL+.Colposcopy-negative quadrant biopsy detected 34 cases of CINⅠand 81 cases of HSIL+,the Kappa value was 0.644 compared with the pathologial examination(P<0.05),and the diagnostic accuracy was 73.04%.High-risk HPVE6/E7 mRNA detection detected 26 cases of CINⅠand 89 cases of HSIL+,the Kappa value of high-risk HPVE6/E7 mRNA detection and pathological examination results was 0.453(P<0.05),and the diagnostic accuracy was 80.87%,40 cases of CINⅠand 75 cases of HSIL+were detected by colposcopic negative quadrant biopsy combined with high-risk HPV E6/E7 mRNA detection,the Kappa value of colposcopic negative quadrant biopsy combined with high-risk HPV E6/E7 mrna detection was 0.708(P<0.05)and the diagnostic accuracy was 87.83%.The Reid score of co
作者
游维
靳风英
王玲玲
YOU Wei;JIN Fengying;WANG Lingling(Department of Gynecology,Guang′an People′s Hospital,Guang′an,Sichuan 638000,China)
出处
《检验医学与临床》
CAS
2024年第15期2204-2208,共5页
Laboratory Medicine and Clinic
基金
2021年四川省医学(青年创新)科研课题(Q21210)。
