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Objective:To investigate the incidence of high-risk human papillomavirus (hrHPV) negative cervical lesions in the screening population, and based on this, to preliminarily evaluate the potential harm (missed diagnosis) and benefits (reduced colposcopy referral) of HPV primary screening compared to combined screening so as to provide reference for the selection of cervical cancer primary screening methods.Methods:This study was a single center cross-sectional study. Women who underwent joint screening [hrHPV typing test combined with cervical liquid based cytology test (LCT)] at the Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from January 1, 2018 to December 31, 2019 were included in the cervical cancer screening. The proportion of hrHPV negative cytological abnormalities and cervical lesions in the population was analyzed and the theoretical colposcopy referral rate of the combined screening and HPV initial screening protocol was calculated. In the population with cervical pathological results, the number of colposcopy examinations required for the diagnosis of cervical intraepithelial neoplasia grade 2 and above (CIN2+ ) was calculated.Results:A total of 35 321 screened women were included. The overall incidence of hrHPV infection, LCT abnormalities and severe LCT abnormalities in the population was 17.13%(6 051/35 321), 18.07%(6 384/35 321), and 3.97%(1 402/35 321), respectively. The negative rate of hrHPV in women with severe cervical cytology abnormalities was as high as 51.28%(719/1 402), and in CIN2+ lesions diagnosed by cervical biopsy, hrHPV negative accounted for 7.15% (49/685). The theoretical colposcopy referral rates for combined screening and initial HPV screening were 11.28%(3 985/35 321) and 8.33%(2 943/35 321), respectively, with an average diagnosis of CIN2+ requiring 3.51 and 2.81 colposcopy examinations, respectively.Conclusions:In the opportunistic screening population, the proportion of hrHPV negative CIN2+ lesions cannot be ignored, and the HPV initial screening strategy may cause missed diagnosis of these lesions. However, compared to combined screening, HPV initial screening has the potential to improve the efficiency of colposcopy. These results suggest that we should carefully choose the HPV initial screening plan.
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Cervical cancer is still a serious threat to the health of women in China. The current strategy is a three-level prevention strategy, among which the diversion of screening and screening abnormalities in the secondary prevention is an important link in preventing cervical cancer. For more than 20 years, China has implemented diversified screening methods such as cytological examination, high-risk human papillomavirus (HPV) testing, and naked eye screening. With the discovery that high-risk HPV infection is closely related to the occurrence of cervical cancer, the screening method for cervical cancer has shifted from cytological examination to HPV testing as the preferred screening method. This article introduces the advantages and disadvantages of high-risk HPV testing and cytological examination as screening methods, and proposes the issues that need to be paid attention to in screening; The principle of diverting screening abnormalities was proposed, and it was proposed that in the process of diverting, individualized and refined management principles should be implemented for screening abnormality projects based on the patient′s age and fertility requirements.
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Objective:To explore the characteristics of cervical lesions in female patients in the Shihezi region of Xinjiang in the past two years and provide guidance for clinical work and local cervical cancer screening.Methods:The clinicopathological data and characteristics of 1 080 patients with abnormal double screening of human papilloma virus (HPV) and cervical exfoliative cell test (TCT) and vaginal mirror cervical tissue biopsy in the gynecology department of the First Affiliated Hospital of Medical College of Shihezi University from May 2017 to March 2019 were analyzed retrospectively. The influencing factors of cervical lesions were analyzed by logistic regression.Results:(1) Uneducated [odds ratio ( OR)=2.267], irregular vaginal bleeding ( OR=3.275) and number of sexual partners ≥3 ( OR=3.052) were independent risk factors for cervical lesions. (2) Cervical intraepithelial neoplasia (CIN) was detected most frequently in the 30-39 age group (57.54%), and cervical cancer was detected most frequently in the ≥60 age group (14.15%), followed by the 40-49 age group (2.20%). (3) The proportion of HPV positive and the positive rate of high-risk HPV16/18 in the 40-49 age group were the highest, 33.18% and 39.38% respectively. There was no statistically significant difference in HPV viral load between the different age groups ( P>0.05). (4) The detection rates of CIN3 and cervical cancer were higher in the HPV16/18-positive group than in the HPV-positive and TCT≥atypical squamous epithelial cells of undermined significance (ASC-US) group (18.34% vs 11.33%, 4.30% vs 1.82%), with statistically significant difference (all P<0.05), respectively. The detection rate of CIN2 was higher in the high-load group (28.44%) than in the medium-load group (25.32%) and the low load group (15.79%). (5) The detection rate of CIN3 in the HPV-positive TCT for the ASC-US populations was significantly higher in the HPV16/18-positive group than in the other subtypes of HPV-positive group (21.43% vs 8.33%, P<0.05). Conclusions:During cervical cancer screening in Shihezi region, we should strengthen the publicity of elderly women and uneducated people. CIN and cervical carcinoma in Shihezi region are closely associated with high-risk HPV infection, especially HPV16/18 infection. HPV-positive age is mainly concentrated in the age group of 40-49 years, and the detection rate of CIN and cervical cancer is the highest in the age group of 30-39 years and ≥60 years, respectively. The detection rate of ≥CIN2 in HPV16/18 fraction and high viral load population is higher than that of other HPV subtypes positive and low to medium load populations. How to effectively shunt HPV positive TCT is an important problem in ASC-US population, which needs further research.
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Objective:To explore the detection capability of p16/Ki-67 double staining technique in women with various abnormal thinprep cytologic test (TCT) results and its diagnostic value for cervical intraepithelial neoplasia Ⅱ+ grade (CIN2+).Methods:A total of 225 women with abnormal TCT results, i.e. the atypical squamous cells of undetermined significance(ASC-US), in the Tianjin Central Hospital of Gynecology Obstetrics, Nankai University Affiliated Maternity Hospital from December 2018 to December 2019 were enrolled. p16/Ki-67 double staining were detected and compared with the high risk human papillomavirus (HR-HPV) and pathological results.Results:The positive rates of p16/Ki-67 double staining increased with cytologic and pathologic categories. For diagnosis of CIN2+, p16/Ki-67double staining (90.1%) was less sensitive than HR-HPV testing (98.2%)( P<0.05), but the specificity of p16/Ki-67 double staining (58.8%) was significantly higher than HR-HPV(21.6%) ( P<0.001). Conclusions:Compared with HR-HPV, p16/Ki-67 double staining has better effect on diagnosing CIN2+. p16/Ki-67 double staining can be considered as triaging method for management of ASC-US and LSIL patients, significantly reduce the colposcopy referral rate (nearly 50%), which has high clinical application value.
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Objective@#To compare the indirect immunofluorescence staining effect of urinary podocytes by thinprep liquid-based cytologic test (TCT) with that by the conventional centrifugal smear method, and explore its clinical application value. @*Methods@#The morning urine samples from 50 patients with type 2 diabetic nephropathy and 14 healthy controls were smeared with the TCT and conventional centrifugation method, respectively, and then the indirect immunofluorescence staining were performed to observe the morphology of podocytes. @*Results@#For 64 urine samples, the satisfactory rate of TCT smears (85.94%) was significantly higher than that of conventional smears (50.00%), and the podocyte detection rate of TCT smears (73.47%) was also significantly higher than that of conventional smears (51.02%) (P＜0.05). When urinary podocytes of the same patient were positive by both methods, the reading effect of TCT smears was obviously superior to that of conventional smears. @*Conclusion@#The TCT combined with indirect immunofluorescence staining is obviously superior to the conventional centrifugal smear method in the podocyte diagnosis of urine samples.
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Purpose To investigate the diagnostic value of p16/Ki-67 dual stain cytology for detection of cervical precancerous lesions as a novel option for cervical lesions screening.Methods A total of 295 cases diagnosed as atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) from thinprep cytologic test (TCT) were selected.Double staining of p16/Ki-67 cytology,vaginal biopsy,biopsy and pathological examination were applicated,p16/Ki-67 dual stain cytology was compared with that of biopsy and pathological examination.At the same time,The sensitivity and specificity of p16/Ki-67 dual stain cytology between ASC-US and LSIL was analyzed.Results The positive rate of p16/Ki-67 dual stain cytology were 37.42％ and 36.36％ in ASC-US and LSIL,respectively.The positive rate of cervical intraepithelial neoplasia 2/3 (CIN2/3) were 25.77％ and 25.76％.The sensitivity and specificity of the p16/Ki-67 test for detecting CIN2/3 was 83.33％ and 78.51％.The sensitivity and the specificity of the p16/Ki-67 test for detecting CIN2/3 was 85.30％ and 80.61％ in LSIL group.Conclusion p16/Ki-67 double stain cytology detection can improve the sensitivity of CIN2/3 and the specificity of human papilloma virus (HPV).p16/Ki-67 double stain detection can effectively triage the high grade cervical lesions in TCT and improve the accuracy of cervical cancer screening.
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Objective To understand the genotypic infection status of human papilloma virus (HPV) in patients with gynecological diseases in Shanghai, and to analyze the diagnostic value of HPV genotyping in cervical disease, so as to provide reference for rational application of screening methods. Methods We analyzed the examination results of 12 670 patients with various gynecological diseases who voluntarily receivedthe HPV genotyping test in Tongren Hospital Affiliated to Shanghti Jiaotong University School of Medicine in 2016, and statistically analyzed the infection status of different genotypes of HPV. Among them, 504 cases with clinical symptoms or HPV infection received ThinPrep cytologic test (TCT) and colposcopy histopathological examination. The relationship between high-risk HPV infection and cervical lesion was analyzed according to the pathological diagnosis of cervical lesions. Results The overall HPV infection rate was 23.66% (2 998/12 670), of which 84.09% (2 521/2 998) were infected with high-risk type HPV; the overall infection rate of high-riskHPV was 19.90% (2 521/12 670), and the overall infection rate of low-risk HPV was 3.76% (477/12 670). Among the patients infected with HPV, the rate of single type infection was 71.21% (2 135/2 998), the rate of double infection was 16.94% (508/2 998), and the remaining were infectedwith more than two types. There were no significant differences in low-risk HPV infections between different age groups, while the patients in low-age group had high infection rate of high-risk HPV (P<10.01). In the high-risk HPV infection, the five subtypes of the highest infection rate were HPV52, HPV16, HPV53, HPV58, and HPV51. In the low-risk HPV infection, the top three infection types were HPV81, HPV43, and HPV42. With the escalation of cervicai lesions levei, the infection rate of high-risk HPV was increased. HPV genotyping was more sensitive than TCT in screening cervicai disease, and its negative predictive value was higher, which had great significance for ruling out cervicai cancer. HPV infections in cervicai cancer cases were HPV16, HPV18 and HPV52. Conclusion HPV genotyping has high accuracy and clear genotype, and is more effective in screening cervicai lesions when combined with TCT and histology, contributing tothe prevention and treatment of cervicai cancer. HPV genotyping has high sensitive and negative predictive value in screening cervicai lesions, indicating that it can replace TCT or combine with TCT in initiai cervicai cancer screening.
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Objective To investigate relativity between the epidemiology of HPV and cervical carcinoma in Dali region,Yunnan province,through detecting the 13 high-risk human papillomavirus infection and Thinprep cytologic test in 2153 cases.Methods Real-time PCR was used to detect the 13 high-risk HPV (16,18,31,33,35,39,45,51,52,56,58,59,68) in2153 cases and 1604 cases were checked with Thinprep cytologic test.Results In 2153 samples,260 cases were infected with HPV,with the positive rate of 12.08％.The highest positive rates were ＞60 years old (18.18％),then ＞20 and ≤30 years old (14.41％);there was no significant difference in the positive rate among the various age groups (P =0.384).There were 1465 negative for intraepithelial lesion ormalignancy (NILM) cases (91.33％),86 atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot exclude HSIL (ASC-H) cases (5.36％),32 low-grade squamous intraepithelial lesion cases (LSIL) cases (2.00％),21 high-grade squamous intraepithelial lesion cases (1.31％) through Thinprep cytologic test.The correlation coefficient is 0.893.Conclusions The infection rate of HPV in Dali region,Yunnan Province,has no significant difference among the various age groups.Application of 13 high-risk HPV infection test combined with Thinprep cytologic test could be more effective in screening cervical carcinoma.
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Objective To investigate the clinical application value of gene chip method for detecting human papilloma virus (HPV) DNA genotype .Methods A total of 372 samples of HPV genotype in the gynecological outpatients department of our hos‐pital from September to December 2015 were collected ,including 22 kinds of genotype(18 types of high risk ,4 types of low risk) , meanwhile all samples were performed thinprep cytologic test(TCT) .Results In 372 samples ,223 cases of HPV gene were detec‐ted with the detection rate of 59 .94% ,194 cases(52 .15% ) of high risk type and 194 cases(7 .80% ) of low risk type were detected ;the abnormal rate of TCT was 44 .08% (including atypical hyperplasia ,low‐grade and high‐grade lesion) ,the atypical hyperplasia was 22 .88% ,the detection rate of high‐grade lesion was 5 .10% and which of low‐grade lesion was 18 .01% .In the cervical lesions showing the lesion beyond inflammation ,multiple infection and cervical lesions had significant correlation (P<0 .05) .Conclusion HPV genotyping has higher clinical application in the cervical lesion screening ,moreover which has good correlation with the cyto‐logical change .Conducting HPV genotyping is beneficial to the early screening of cervical lesions .
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Objective To investigate the clinical significance of human papillomavirus(HPV )genotype combined with thinprep cytologic test(TCT )in the diagnosis of cervical lesion .Methods A total of 473 patients were checked for 21 subtypes of HPV by diversion hybrid gene chip technology ,TCT and colposcope biopsy were also detected at the same time .The histology was selected as a gold standard to analyze the tested results .Results The over all positive rate of HPV in 473 patients was 35 .7% .The positive rate of high risk HPV(HR‐HPV) was 32 .1% ,the positive rate of TCT was 26 .6% ,the sensibility ,specificity ,false negative rate , positive predictive value and negative predictive value between HR‐HPV detection and TCT detection were no statistical signifi‐cance(χ2 = 3 .444 ,P= 0 .063) .The sensibility ,specificity ,false negative rate ,positive predictive value and negative predictive value of combining test were 95 .8% ,77 .7% ,4 .2% ,52 .3% and 98 .7% ,the sensibility and negative predictive value improved notably , and the omission diagnose rate decreased significantly(P< 0 .05) .Conclusion HPV genotype combined with TCT detection could significantly improve sensibility and negative predictive value and decrease omission diagnose rate in diagnosis of cervical lesion .
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Objective To understand the main genotypes ,age distribution and infection situation of women cervical human papil‐lomavirus (HPV) infection ,and to investigate the clinical value of the HPV genotype detection combined with thinprep cytology test(TCT ) in screening the cervical lesions .Methods The detection results in 3 272 women voluntarily receiving the cervical cancer screening ,HPV genotype detection and TCT examination in the gynecology clinic of our hospital from January 2012 to December 2013 were performed the statistical analysis .Results Among 3 272 cases ,841 cases were HPV positive with the positive rate of 25 .70% and mainly concentrated in 25 - < 50 years old ,in which 714 strains were high‐risk subtype (including mixed infection) , accounting for 84 .90% ,the HPV type 16 ,52 ,58 ,18 were in the top four ,the multiple infection was in 185 cases (at least one kind of high risk type was detected out in each case of multiple infection) ;253 cases were TCT positive with the positive rate of 7 .73% , in which 167 cases were abnormal diagnosed by the pathological biopsy ,the coincidence rate reached 66 .01% ,among 167 cases of positive pathological biopsy ,166 cases were HPV infection ,7 cases of cervical cancer all were infected by high‐risk type HPV .Con‐clusion The HPV subtype detection combined with TCT can significantly increase the positive rate of cervical cancer screening , which conduces to achieve early prevention ,early discovery ,early treatment for reducing the incidence of cervical cancer .
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Objective To study the application value of the cervical cell pathology liquid production technol-ogy in cervical intraepithelial neoplasia (CIN)screening.Methods 4 212 patients were chosen and detected by TCT and the pap staining,TBS (the Bethesda system)to finish thin layer liquid based cytology grading diagnosis,including 558 patients with cervical biopsy,the pathological results were analyzed.Results for histopathological examination results of CIN1,CIN2,CIN3 and cervical cancer cases,a thin layer of liquid based cytology detection rate was 76.00%(57 /75),78.21%(61 /78),95.76%(113 /118),100.00%(7 /7),the comparison between the CIN3 CIN2 group,a thin layer of liquid based cytology detection rate had differences in significant statistical significance (χ2 =14.53,P <0.01),with the histopathological detection of cervical lesions,thin layer of liquid based cytology detection rate was obviously rising trend.Cervical liquid based cytology screening cervical lesion (CIN and above),the sensitiv-ity was 85.61%(238 /278),83.73%(206 /246),positive predictive value 76.28%(238 /312),negative predictive value 72.79%(206 /283).Conclusion The positive results and histopathological results coincidence rate of using thinprep cytologic test to screening for cervical intraepithelial neoplasia (CIN)is high,the precancerous lesions in screening and prevention has important significance,which is worth clinical promotion.
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Objective: To optimize the process of making cell blocks by residual pleural and peritoneal effusions, and to explore its value in pathological diagnosis. Methods: Totally 150 residual pleural and peritoneal effusion specimens of thinprep cytologic test (TCT) were evenly divided into 3 groups according to cytopathological diagnosis. Specimens in the three groups were processed by direct centrifugal method, egg white as the bracket method and cell block test method. The detection rate of malignant cells, distribution status and morphological features of cells on the cellular sections were compared between the three different method s, and the immunohistochemical staining results were compared between the cell block and tissue block. Results: The TCT yielded a detection rate of malignant cells of 31. 3% (47/150), and examination of the cell block in this study yielded a detection rate of 40. 7% (61/150), with the rates of direct centrifugal method, egg white as the bracket method and cell block test method being 26. 0% (13/50), 46. 0% (23/50) and 50. 0% (25/50), respectively. The detection rates of malignant cells in egg white as the bracket method and cell block test method groups were significantly higher than that in the direct centrifugation method (P<0. 05); in addition, the former two groups also had better cell aggregation and distribution. The immunohistochemical staining results of cell blocks were also similar to those of tissue blocks. Conclusion: The cell blocks processed by egg white as the bracket method and cell block test method can improve the detection rate of malignant cells in residual pleural and peritoneal effusion, and the blocks can be used for immunocytochemistry staining.
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Objective To evaluate the clinical value of thinprep cytologic test(TCT)and the Bethesda system(TBS)for the diagnosis of early cervical diseases.Methods A total of 635 patients in our hospital had been examined by TCT and TSB from December 2005 to 2006.the abnormal cases which had been selected by TCT were detected by colposcopical pathological examination and Hybrid Capture Ⅱ HPV testing.Results We found 66(10.23%)abnormal smears out of 635 cases,in which atypical squamous cell of undetermined significance(ASCUS)37 cases(5.83%),low grade squamous intraepithelial lesion(LSIL)18cases(2.80%),high grade squamous intraepithelial lesion(HSIL)10 cases(1.57%),quamous cellcarcinoma 1case(0.16%).The rates of coordinance with pathological results of colposcopy and HCⅡ were 92.95% and 87.00% respectively.Conclusions TCT and TBS,sometimes combined with the colposcspy and HPV DNA test,may be a reliable method to screen and diagnose the precancerosis of cervix.
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Objective To investigate the diagnostic value of thinprep cytologic test(TCT) and electronic colposcope(EC) examination in patients with subclinical human papillomavirus(HPV) infection(SPI) and cervical intraepithelial neoplasia(CIN),and explore its concordance with pathologic diagnosis. Methods A total of 1 125 females were examined with TCT,744 of whom diagnosed with abnormality by TCT or suspect of cervical lesions were examined with EC,and multiple punch biopsies were performed in 706 of those with abnomal EC images and suspected diseases. ResultsThe sensitivity of TCT,EC examination and the combined examination of TCT and EC for SPI and CIN were 88.74%,88.79% and 90.63%,respectively,the specificity 85.44%,80.38% and 96.41%,respectively,the positive predictive value 74.06%,68.90% and 91.10%,respectively,and the negative predictive value 94.19%,93.61% and 96.21%,respectively.By the combination of the two examinations,the specificity and positive predictive value were significantly increased(P
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Objective To investigate the efficiency of three methods to detect HPV infection of desquamated cervical epithelial cells and the relationship between methods and TCT.Methods hC2 method was used in disconnecting the HPV DNA chain in the samples to hybrid captures,and examine the 13 types of HPV which were highly related to cervical carcinoma.Q-PCR was first used to extract HPV DNA of samples and expanded nucleotide to be examined on Q-PCR to obtain results directly.MPHC was used to extract HPV DNA and to amplify nucleotide.The products was added to micro-well plate to proceed hybridization,and enzyme label was added,and results were studied in the enzyme labelling apparatus.The results of the latter two methods were the same as hC2.hC2 matched Q-PCR was used to examine 260 eases of desquamated cells from HPV infection against 200 cases of desquamated cells from HPV infection,and the results were compared by using MPHC matching examination.Results 1.With three methods,HPV infection was found to be 100% in all the abnormal cervical squamous epithelial cells.2.The sensitivity of the methods,howerer,was different.The QFCR and MPHC had higher positive rate than hC2.Positive HPV infection rate with Q-PCR and MPHC was the same as that of hC2 in the majority of cases,as in a few cases,it was positive with Q-PCR and MPHC but negative with hC2 alone False positive rate was 2% in MPHC.Conclusion HPV testing combined with the TCT routine is the best screening program for detecting cervical cancer and precursor of cervical careinoma.