Application of thinprep cytologic test combined with high risk human papillomavirus test in diagnosis of cervical precancerous lesion

Objective To investigate the clinical significance of thinprep cytologic test( TCT) combined with high risk human papillomavirus( HPV) test in the diagnosis of cervical precancerous lesion. Methods The clinical material of 1 049 patients who accepted the examinations of TCT,high risk HPV test and colposcope biopsy at the same time were collected. The histology was selected as gold standard to analyze the tested results. Results Seven hundred and twenty-five patients of 1 049 patients were infected by high risk HPV,the over all positive rate was 69. 11%. The results of cytology showed that 414( 39. 47%) patients were negative for intraepithelial lesion or malignancy( NILM),275( 26. 22%) patients were atypical squamous cells of undetermined signification( ASCUS),73( 6. 96%) patients were atypical squamous cells-can' t exclude HSIL( ASC-H),168( 16. 02%) patients were low-grade squamous intraepithelial lesion( LSIL),109( 10. 39%) patients were highgrade squamous intraepithelial lesion( HSIL) and 10( 0. 95%) cases were squamous cells cancer( SCC). The positive rate of high risk HPV was 37. 68%,86. 55%,89. 88%,90. 41%,95. 41% and 100. 00% respectively. The positive rate of HPV in abnormal histology group was significantly higher than that in NILM group( P = 0. 000 0). The positive rate increased with severity of cervical cytologic lesions. According to the pathological diagnosis,703( 67. 02%) patients were chronic cervicitis,10( 0. 95%) patients were condylomata,131( 12. 49%) patients were cervical intraepithelial neoplasia( CIN) Ⅰ,40( 3. 81%) patients were CINⅡ,133( 12. 68%) patients were CINⅢ and 32( 3. 05%) patients were SCC. The positive rate of high risk HPV was 57. 18%,70. 00%,90. 84%,95. 00%,95. 49% and 100. 00% respective. The positive rate of high risk HPV in abnormal histology group was significantly higher than that in chronic cervicitis group and condylomata group( P 0. 05). The positive rate increased with severity of cervical histologic lesions. In HSIL group,the incidence rates of CINⅡor worse with high risk HPV infection were 84. 62%( 88 /104),which was significantly higher than 20. 53%( 31 /151) of LSIL group,the difference was statistically significant( χ2= 101. 621 4,P = 0. 000 0). In ASCUS group,the incidence rate of CIN with high risk HPV infection was 29. 83%( 71 /238),which was significantly higher than 13. 51%( 5 /37) of patients with high risk HPV negative,the difference was statistically significant( χ2= 4. 263 8,P = 0. 038 9). TCT combined with HPV test in the diagnosis of cervical lesions could decrease omission diagnose rate from 8. 96%( 31 /346) to 2. 02%( 7 /346),the difference was statistically significant( χ2= 16. 038 6,P = 0. 000 1). The sensibility,specificity,positive predictive value and negative predictive value of TCT were 91. 04%,54. 48%,49. 61% and 92. 51%. After combining with high risk HPV test,above index were 97. 98%,35. 70%,42. 86% and 97. 29% respectively. The sensibility and negative predictive value improved notably( P 0. 05). Conclusion TCT combined with high risk HPV test can greatly improve sensibility and negative predictive value.