1 467例阴道上皮内瘤变的液基细胞学及HPV检测的回顾性分析

 目的  评估液基细胞学和人乳头瘤病毒(human papillomavirus, HPV)检测在筛查阴道上皮内瘤变(vaginal intraepithelial neoplasia, VaIN)中的意义。方法  收集2014年1月至2015年12月在复旦大学附属妇产科医院宫颈疾病诊疗中心进行阴道镜检查并发现VaIN的患者, 对其临床病理资料进行回顾性分析。结果  收集VaIN或VaIN合并宫颈上皮内瘤变(cervical intraepithelial neoplasia, CIN)患者1 467例, 其中VaINⅠ1 227例, VaINⅡ~Ⅲ 240例。患者的平均年龄(45.8±12.6)岁。310例患者曾行子宫切除术。共获得1 296例(88.3%)患者的液基细胞学检测结果, 在单纯VaINⅠ、单纯VaINⅡ~Ⅲ、子宫切除术后VaINⅠ、子宫切除术后VaINⅡ~Ⅲ的患者中细胞学灵敏度分别是62.7%、69.8%、70.3%和74.5%; 共获得1 125例(76.7%)患者的HPV检测结果, 在以上4组患者中HPV灵敏度分别是84.5%、88.7%、85.0%和91.4%; 联合筛查的灵敏度在以上4组患者中分别是94.4%、93.9%、97.5%和95.9%。HPV检测灵敏度均高于液基细胞学(P<0.05)。结论  液基细胞学和HPV检测在筛查VaIN中非常重要, HPV检测灵敏度高于液基细胞学, 建议联合筛查。在子宫切除患者的随访中应尤其重视液基细胞学和HPV检测。

Retrospective analysis of liquid based cytology and HPV test on 1 467 cases of vaginal intraepithelial neoplasia

Objective  To evaluate the importance of liquid based cytology and human papillomavirus (HPV) test in screening vaginal intraepithelial neoplasia (VaIN). Methods  All medical records of VaIN patients diagnosed by colposcopy directed biopsy (CDB) from Jan., 2014 to Dec., 2015 in Obstetrics and Gynecology Hospital, Fudan University were retrospectively reviewed. Results  Total 1 467 patients with VaIN or VaIN with cervical intraepithelial neoplasia (CIN) were diagnosed by CDB. Among them, 1 227 patients had VaINⅠ, 240 patients had VaINⅡ-Ⅲ. The average age was (45.8±12.6) years. Results of cytology were available in 1 296 cases (88.3%). Sensitivity of cytology was 62.7%, 69.8%, 70.3% and 74.5% in simple VaIN Ⅰ, simple VaIN Ⅱ-Ⅲ, VaIN Ⅰ after hysterectomy and VaINⅡ-Ⅲ after hysterectomy respectively. Results of HPV were available in 1 125 cases (76.69%). Sensitivity of HPV was 84.5%, 88.7%, 85.0% and 91.4% in the 4 groups of patients, respectively. Sensitivity of combined screening was 94.4%, 93.9%, 97.5% and 95.9% in the 4 groups of patients respectively. Sensitivity of HPV was higher than cytology (P<0.05). Conclusions  Liquid based cytology and HPV test are both pivotal in VaIN screening. Sensitivity of HPV is higher than cytology. Combined tests are recommended. More attention should be paid to cytology and HPV especially in patients after hysterectomy.