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Objective: To identify appropriate ways of applying the current cervical screening methods to minimize the occurrence of missed diagnosis of high-grade cervical intraepithelial neoplasia (CIN2/3) and cervical cancer. Methods: A retrospective analysis was conducted based on the clinical data of 318 patients, who had CIN2/3 or cervical cancer and were treated in Aviation General Hospital Affiliated to China Medical University between June 2014 and August 2018. Among these cases, 296 involved CIN2/3, and 22 involved cervical cancer. All of the patients involved underwent a thinprep cytology test (TCT) and high-risk human papilloma virus (hrHPV) screening, and their age and TCT and hrHPV results were further analyzed. Results: Among the 296 patients diagnosed with CIN2/3, 130 of them (43.92%) were aged between 30 and 39 years, ranking the top among all age groups. Sixty-nine young patients (23.31%) aged between 20 and 29 years were diagnosed with CIN2/3, ranking in the third place. Among all of the 318 cases, the TCT results were positive in 199 cases (62.58%), hrHPV results were positive in 308 cases (96.86%), and there were 313 cases (98.43%, 313/318) wherein both TCT and hrHPV results were positive according to joint screening. The most predominant hrHPV subtypes were 16, 52, 58, 33, 18, and 31. Conclusions: As an increasing number of young women are diagnosed with CIN2/3 and cervical cancer, their screening should not be ignored. Single use of TCT screening leads to more frequent missed diagnosis of high-grade lesions compared with single use of hrHPV screening, while joint use of both screening methods could improve the detection rate. Even if TCT results were negative, it is suggested to conduct a colposcopy for those patients with high-risk subtypes besides hrHPV16 and 18 positivity, and in particular, for patients with hrHPV 52,58,33, and 31 positivity.
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Objective To investigate the feasibility of P16 immunohistochemistry combined with routine pathology in judging the residual lesion of high grade cervical intraepithelial neoplasia.Methods Patients with cervical conization for high grade cervical intrapithelial neoplasia in this hospital from January 2014 to May 2016 were chose and divided into P16 immunohistochemical detection combined with pathological diagnosis group and pathological evaluation group according to patient's motivation.Patients with residual margins were treated in accordance with the clinical guidelines and TCT was followed up for 6 months after no margin.Then sensitivity and accuracy of two group were analyzed by gold standard of follow-up results.Results 104 patients in P16 immunohistochemical detection combined with pathological diagnosis group were negative in TCT test after 6 month of following up after surgery.However,at the time of 6 months follow-up after surgery,7 patients of 112 patients have been diagnosed with positive by TCT in pathological evaluation group.The Sensitivity and accuracy in P16 immunohistochemical detection combined with pathological diagnosis group were 100％ which were higher than pathological evaluation group.Conclusion P16 immunohistochemical detection combined with conventional pathology can accurately diagnose the cervical cutting edge of conization.
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Objective To explore the diagnostic value of HR -HPV combined with TCT in the diagnosis of cervical cancer and precancerous lesion.Methods 1 198 cervical specimens were selected for the study.The results of HR -HPV detection and TCT detection were analyzed,with the pathological results as the gold standard,the diag-nostic value of HR -HPV and TCT in the diagnosis of cervical cancer and precancerous lesion were discussed. Results With increasing pathological grade,TCT positive rate increased gradually,there was a correlation between them(r =0.629,P <0.05).With increasing pathological grade,HR -HPV positive rate increased gradually,there was a correlation between them(r =0.684,P <0.05).The sensitivity of HR -HPV combined with TCT in the differ-ential diagnosis of cervical cancer,precancerous lesions was 100.00%,specificity was 79.64%,missed diagnosis rate was 0.00%,the misdiagnosis rate was 20.36%.Conclusion HR -HPV combined with TCT examination has high clinical value in the diagnosis of cervical cancer and precancerous lesions.
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Objective To determine the application value of quantitative detection of DNA in cervical lesion screening.Methods Retrospective analysis of 82 518 cases of cervical lesions was carried out.The sensitivity,specificity,positive predictive value (PPV),and negative predictive value (NPV) of DNA quantification and ThinPrep cytology test (TCT) for the diagnosis of cervical lesions were compared with the results of biopsy.The accuracy of the two methods was evaluated by applying the receiver operating characteristic curve.Results The sensitivity of DNA quantification,TCT,and combined diagnosis was 77.37％,70.97％,and 90.24％,respectively,and the specificity was 65.59％,70.42％,and 45.06％,respectively.The sensitivity of cell DNA quantitative analysis was higher but the specificity was lower than that of TCT,while the sensitivity of combined diagnosis was the highest.In DNA quantitative analysis of patients with and without atypical squamous cells of undetermined significance (ASCUS),the positive rates of pathology were 42.71％ and 12.5％,respectively.The misdiagnosis rate of cell DNA quantitative analysis for screening cervical adenocarcinoma (39.13％) was higher than that for screening cervical squamous cell carcinoma (15.11％).In a cytologic smear,the misdiagnosis rate of cells ＜ 5 000 (57.83％) was much higher than that of cells ＞ 5 000 (22.63％).However,a combined diagnosis with TCT could reduce the misdiagnosis rate from 20.19％ to 13.38％.Conclusion Cell DNA quantification is more sensitive than TCT,but the specificity of cell DNA analysis is lower than that of TCT,and the screening rate for cervical adenocarcinoma is high.Quantitative DNA analysis combined with TCT can significantly improve the screening sensitivity.
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Objective To analyze the application value of high risk human papillomavirus (HR HPV) DNA and thinprep cytolo-gy test(TCT ) detection in screening cervical cancer and to evaluate the clinical significance of their combined detection .Methods A total of 402 cases conducting cervical cancer screening in our hospital from March to May 2016 were selected and performed the HR HPV DNA and TCT detection .Those of suspected cervical lesions were performed the histopathological examination .Then the effects of HR HPV DNA and TCT combined detection were compared according to the pathological results .Results The detection positive rate of female HR HPV DNA was 27 .1% (109/402);abnormal and benign inflammation reaction were detected out in 46 cases of female TCT ,the positive rate was 11 .4% (46/402);in 123 cases of suspected cervical malignant lesion ,32 .5% females(40/123) appeared CIN Ⅰgrade or more lesions by histopathological examination ;the sensitivity of HR HPV DNA and TCT combined detection was higher than that of single detection ,the difference was statistically significant (P0 .05) .Conclusion The detection of HR HPV DNA and TCT is a good method for screening of cervical cancer ,the combined detection of HR HPV DNA and TCT can improve the detection rate of cervical precancerous lesion .
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Objective To explore the value of cervical lesions screened with white acetate solution. Methods Four hundred and eighty-five patients who were suspected with cervical lesion during Janurary to March 2016 were enrolled in this study. The patients were asked about the medical history, filled the registration form, and performed routine gynecological examinations with white acetate solution, thinprep cytology test (TCT) and vaginal endoscopic biopsy. The value of white acetate solution in clinic was assessed. Results In 485 patients, 450 patients (92.78%) were pathologically diagnosed of inflammation (92.78%), 24 patients (4.95%) were diagnosed of low-grade squamous intraepithelial lesion (LSIL), 10 patients (2.06%)were diagnosed of high-grade squamous intraepithelial lesion (HSIL), and one patient (0.21%) was diagnosed of cervical cancer. The detection rate of white acetate solution and TCT were gradually increased with the increase of the degree of cervical lesions. The detection rate of white acetate solution in the inflammation was 1.33%, in LSIL was 91.67%, in HSIL was 9/10, and in cervical cancer was 1/1. The detection rate of TCT in the inflammation was 8.44%, in LSIL was 66.67%, in HSIL was 6/10, and in cervical cancer was 1/1. The sensitivity, specificity and coincidence rate of the diagnostic results with white acetate solution were 84.21%, 99.33%, 98.14%, and with TCT were 62.30%, 93.63%, 89.69%. There were significant differences (P<0.05). Conclusions Cervical lesions screened with white acetate solution is good in sensitivity and specificity, which is an effective way for screening cervical cancer.
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Objective To investigate the application value of human papillomavirus (HPV) combined with thinprep cytology test (TCT) detection in screening of cervical cancer. Methods 276 patients were enrolled to have HPV and TCT tests at Department of Gynecology, Shanxi Cancer Hospital from January to December in 2014. Pathological examine was applied to the patients with abnormal results of HPV and TCT. The diagnostic value of HPV, TCT and their combinations was evaluated by the diagnostic sensitivity and the rate of coincidence with the pathological examine results. Results The sensitivity of HPV and its coincidence with the pathological examine results were 81.52 % (225/276) and 79.56 % (179/225), respectively, while those of TCT were 87.68%(242/276) and 76.86%(186/242), respectively. The coincidence rate between the combination method and the pathological examination was higher (94.71%, 197/208) than the individual test. Conclusion HPV combined with TCT detection can reduce the misdiagnosis rate and improve the diagnostic accuracy rate, indicating that this method is of great value in the cervical cancer screening.
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Objective To study the status of coincidence of high-risk human papillomavirus(HR-HPV)test and thinprep cytolo-gy test with biopsy histopathologic diagnosis.And to investigate the value of combined detection in the diagnosis of the cervical cancer and precancerous lesions.Methods High-risk HPV test and thinprep cytology test were taken simultaneously in 1374 pa-tients visiting department of gynecological oncology.The diagnostic value of combination assay of these indices was evaluated.Re-sults In 684 patients with ASCUS pathology diagnosis,inflammation accounted for 5 1.3% and CINⅠ accounted for 47.4%.A-mong the 375 patients with LSIL pathology diagnosis,CINⅠ accounted for 48.5% and CIN Ⅱ-Ⅲ accounted for 21.3%.Among the 294 patients with HSIL pathological diagnosis,CIN accounted for 24.5%,and CIN Ⅱ-Ⅲ accounted for 62.9%.Among 20 pa-tients with SCC pathology diagnosis,CIN Ⅱ - Ⅲ accounted for 20% and cervical cancer accounted for 80%.Statistical analysis showed the difference of diagnostic results between thinprep cytology test and histopathologic diagnosis was statistically significant (P <0.05).The positive rate of high-risk HPV was 74.3%,and the negative rate was 25.7%.The positive rate of high-risk HPV significantly increased along with the rise of pathological level.The difference of pathologic diagnosis results between high-risk HPV positive group and negative group was statistically significant (P <0.05).When thinprep cytology test combined with high-risk HPV test,its sensitivity was 76.5%,and the specificity was 80.3%.The difference of the sensitivity between joint detection and thinprep cytology test was statistically significant (P <0.05).The difference of the specificity between joint detection and high-risk HPV test was statistically significant (P <0.05).Conclusion Combined thinprep cytology test and high-risk HPV test will improve the detection rate of cervical lesions and it is an ideal method to screen for cervical cancer.
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Objective To explore the diagnostic value of bronchofiberscopic washing cytology (BWC) and bronchoalveolar lavage fluid (BALF) ThinPrep cytology test (TCT) in the diagnosis of lung cancer.Methods Three hundred and eighty-five lung cancer patients who completed the BWC and BALF TCT were selected.The sensitivity was compared between the conventional smear and the two TCT methods.The sensitivity and accuracy of BWC and BALF TCT in the diagnosis of lung cancer were analyzed.Results The sensitivity of TCT was 76.1％ (293/385) in the diagnosis of lung cancer,and conventional smear was 54.8％ (211/385).The sensitivity of TCT was significantly higher than that of conventional smear (P ＜ 0.05).In the diagnosis of central lung cancer,the sensitivity of BWC TCT and BALF TCT was 74.4％ (131/176) and 70.5％ (124/176),and there was no statistical difference (P ＞ 0.05).In the diagnosis of peripheral lung cancer,the sensitivity of BALF TCT and BWC TCT was 83.3％ (174/209) and 44.0％ (92/209),and there was statistical difference (P ＜ 0.05).In BWC TCT,the accuracy of TCT and histology in squamous cancer was 92.7％ (127/137),in adenocarcinoma was 92.6％ (151/163),in small cell cancer was 96.8％ (61/63),and total accuracy was 91.9％ (354/385).In BALF TCT,the accuracy of TCT and histology in squamous cancer was 92.0％ (126/137),in adenocarcinoma was 94.5％ (154/163),and in small cancer was 98.4％ (62/63),and total accuracy was 92.7％ (357/385).Conclusions TCT has more diagnostic value in lung cancer.BWC and BALF TCT show different sensitivity in the diagnosis of lung cancer of different kinds.BWC TCT combination with BALF TCT is helpful to improve the diagnosis of lung cancer.
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Objective To explore the role of thinprep cytology test(TCT)and HPV-DNA hybrid capture detection played in the screening of cervical lesions.Methods Do TCT examination on 9260 outpatients and do HPVDNA hybrid capture detection on 840 cases therein,836 positive cases continued to have biopsy by colposcope,conformed to the gold standard of histopathology and contrast with cytology in the meantime.Results 8374 cases were negative in the TCT examination;836 cases were cytological abnormal.Cytology-positive rate was 9.03％,ASC-US 398 were 4.29％,LSIL 239 were 2.58％,HSIL 179 are 1.93％,SGUS 9 are 0.097％,SCC 11 are 0.12％.The group of 30 ～40 ranked the highest in cytological positive,it's 43.66％,the second highest was the group of 40 to 50,it's 27.39％.The results of other groups were as follow:＜ 30 is 2.85％,50 ～ 60 is 5.14％,＞ 61 is 0.96％ The difference of them was significant ( P ＜ 0.01 ).HPV infection rate was 27.98％ (235/840).In ASC-US,the detectable rate of CIN in the HPV-positive group was 81.58％ (31/38),the HPV-negative group was 8.98％ ( 15/167),there was significant differene between the two methods(P ＜ 0.01 ).In LSIL,the detectable rate of CIN in the HPV-positive group was 95.45％ (21/22).In HSIL,the detectable rate of CIN in the HPV-positive group was 100％ (16/16).The infection rate in different age group is different,the difference was significant ( x2 =25.2 P ＜ 0.01 ) ; 836positive cases had biopsy by colposcope,507 cases were diagnosed to be CIN,the detectable rate was 60.65％ (507/836).To organize pathology as control,the diagnose accordance rate of cytology and pathology of LSIL and HSIL and SCC were 50.46％,82.12％,100％ (P ＜0.01 ).Took their accordance rate into comparison,the differene was significant.Conclusion Cervical lesion was collected in sex activity period,the peak was 31-40 years.TCT is propitious to screen cervical cancer and precancerous lesion,combined with HPV-DNA hybrid capture detection,colposcopy and pathology,can improve the diagnostic accuracy and the detective rate of CIN and cervical cancer.
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Objective To analyze the clinical management of women with atypital squamous cells(ASC).Methods During Sep 2003 to Sep 2008,a totle of 956 women in our department were diagnosed with ASC by cytological test,they were further biopsied under the colposcope.The result of TCT,colposcopic test,biopsy and the highrisk factor were recorded and analysed;the based the biopsy were analyzed by the X~2-test;the high-risk factors and the odds Ratio(OR) were counted by SPSS10.0.Results Among the women with ASC,the rate of cervical intraepithelial neoplasia(CIN) diagnosed by the biopsy under the colposcope was 50.7% ,the rate of the high-grade lesion over CINII Was 13.3% ;if the colposcopic test were low-grade lesion,the rate of the cases which biopsys were the highgrade lesion over CINII,was 8.3% ;the high-risk factors which caused the cervical high-grade lesion were the number of sex-partners over 3,the age less than 20 yearold when the sex were made,the cervical erosion,the result of TCT with ASC-H.Conclusion Among the women with ASC,the biopsy shows multiformity;the rate of CIN and the highgrade lesion is also high;if TCT is ASC,the colposcopie test is advised;if the woman who has the high-risk factors,biopsy is advised.
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Objective To investigate the clinical value of thinprep cytology test(TCT) combined with colposcopy in diagnosis of cervical lesion. Methods Retrospective analysis was conducted in 174 females with abnormal cervical smear. All the patients underwent colposcopy to screen the cervical lesions. According to the pathological results,the clinical value of TCT and colposcopy was analyzed and compared. Results In the 174 cases with abnormal cervical smear,the positive rate of atypical squamous cells(ASC) was 27. 0% (47/174). There were 92 low grade squamous intraepithelial lesion (LSIL) (52. 9%) ,33 high grade squamous intraepithelial lesion (HSIL) (19. 0%) and 2 squamous cell cancinoma (SCC) (1. 1%) . According to the diagnosis by biopsy and pathology,the positive rate of benign cervical cell(BCC) was 16. 1% (28/174) .cervical intraepithelial neoplnsia (CIN) I 42. 0% (73/174), CIN II 18.4% (32/174), CIN ffl 21. 8% (38/174) and SCC 1. 7% (3/174) . The coincidence rate of TCT and pathology was 83. 9% (146/174). Conclusions TCT and colposcopy are a practical approach for detecting cervical lesion. TCT combined with colposcopy is the optimal screening approach for cervical lesion, which can enhance the sensitivity and specificity of the diagnosis of cervical lesions.
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Objective To analyse the abnormal cervical pathology results in cytology and histology.Methods Retrospective analysis of 381 cases of fluid-based thin-layer method(ThinPrep Cytology Test,TCT) and pathology results in our hospital from August.2002 to December 2007.Results Comparing with histopathological examinations results the accuracy of TCT in diagnosis cervical intraepithelial neoplasia was LSIL 92.9%(144/155),HSIL 85.4%(41/48),SCC 100%(5/5),ACA 100%(1/1).Conclusion TCT examination has a good accordance with biopsy results,is on important and preferred means to check cervical precancerous lesions and cervical cancer.
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Objective To study the relativity analysis of abnormal cervical pathology results in cytology and histology.Methods With retrospective analysis of 31,634 cases of fluid-based thin-layer method(ThinPrep Cytology Test,TCT)of PUMC Hospital from January,2001 to March,2003,which reported in the Bethesda System,we checked the abnormal results and advised different diagnose biopsy of vaginoscopy and/or conization,and got the relativity description of abnormal results in TCT and CINⅢ/CIS results validated by vaginoscopy,match analysis of the CINⅡ～Ⅲ and CINⅢ/CIS results validated by vaginoscopy and conization labeled by the age group,and relativity analysis of abnormal results in TCT and CINⅢ/CIS results validated by vaginoscopy.Results Among 31,634 cases of TCT test,948 cases had confirmed biopsy results validated by vaginoscopy,of which 70 cases were of CINⅡ～Ⅲ,56 cases were of CINⅢ/CIS.The risk ratio(RR)of different abnormal TCT results in predicting CINⅢ/CIS results validated by vaginoscopy is:ASCUS group,14.7(95% confidence interval 8.0～27.0,P=0.00);CINⅠ group,13.9(6.3～30.9,P=0.00);CINⅡ group,44.2(15.5～126.5,P=0.00);CINⅢ group,272.2(161.6～458.6,P=0.00);Cancer group,unmeasured.As noted,there is no significant difference between the RR of ASCUS group and CINⅠ group(P=0.951)in predicting CINⅢ/CIS results.Conclusions Vaginoscopy examination and biopsy could verify histology abnormity of CINⅡ～Ⅲ及CINⅢ/CIS from abnormal results of TCT,and has a good accordance along with biopsy results of conization.There are significantly greater risk of being CINⅢ/CIS validated by vaginoscopy in the abnormal TCT patients,among which ASCUS group and CINⅠ group have the coequal risk.