HR-HPV对CIN冷刀锥切后的随访价值
何善阳;袁力;李小利;游泽山;姚书忠
【期刊名称】《中国肿瘤临床》 【年(卷),期】2011(038)015
【摘要】目的:探讨HR-HPV监测CIN冷刀锥切后病变残余或复发的价值.方法:118例冷刀锥切后患者第3、6、12、18、24个月均检测HR-HPV和细胞学及阴道镜,病理证实存在CIN视为残留或复发.结果:术后病理切缘阳性10例(8.5%);术后24个月残留或复发18例(15.3%).术后第6个月HR-HPV转阴率较术后第3个月升高,差异有统计学意义,较6个月后的转阴率无统计学意义.术后第6个月HR-HPV阳性者28例(23.7%),阳性者发病18例(64.3%),阴性患者无发病.术后第6个月HR-HPV诊断病变残留或复发的敏感度和特异度分别为100.0%和90.0%,阳性预测价值和阴性预测价值分别为64.3%和100.0%.HR-HPV与TCT正确诊断率为91.5%和81.4%,Youden's指数为0.900和0.598,HR-HPV优于TCT.切缘阳性者残留或复发率(40.0%)较阴性患者(13.0%)高(P=0.045),切缘阳性者发病风险是阴性者4.5倍(95% CI=1.121～17.866).结论:术后第6个月HR-HPV检测是监测冷刀锥切后病变残留或复发的早期敏感指标,阳性者密切监测,阴性者常规监测不增加发病风险.此外,切缘阳性是病变残留或复发的一个重要危险因素.%Objective: To investigate the significance of high-risk human papilloma virus ( HR-HPV ) DNA testing as a predictor of residual or recurrent cervical intraepithelial neoplasia ( CIN ) after cold-knife conization for high-grade CIN.Methods: HR-HPV testing, cytology, and colposcopy were conducted on 118 female patients at 3, 6,
12, 18, and 24 months after cold-knife conization.Pathology confirmed the existence of CIN as postoperative residuals or the recurrence of the disease.Results: The positive rate of postoperative histopathologic margin was 8.5％ in these patients (10/118).The incidence of residual or recurrent disease was 15.3％ ( 18/118 ) at 24 months after the treatment.The negative HR-HPV rate at 3 months after the surgery was lower than that at 6 months, with statistically significant differences between the two.However, no statistically significant differences were observed between the HR-HPV negative rate at the sixth month after surgery and 6 months later.Up to 28 cases at 6 months after the treatment ( 27.3％ ) were HR-HPV-positive, and 18 of the 28 patients ( 64.3％ ) were positive for CIN.CIN was not detected in the negative cases.At six months after surgery, the sensitivity and specificity of the HR-HPV diagnosis of the residuals of the lesion or the recurrent diseases were 100.0％ and 90.0％, respectively.The positive and negative predictive values were 64.3％ and 100.0％, respectively.The diagnosis accordance rate of the HR-HPV test and the thin-prep-liquid-based cytology test ( TCT ) were 91.5％ and 81.4％, and their Youden's indices were 0.900 and 0.598, respectively.The HR-HPV test was superior to the TCT.In addition, the rate of residual or recurrence was significantly higher in patients with positive margins ( 40.0％ ) than in those with negative margins ( 13.0％ ).The differences were statistically significant
between the two ( P = 0.045 ).The risk of residual or recurrent disease was 4.5 times higher in patients with positive margins than in those with negative margins [OR = 4.476 ( 95％ CI ) = 1.121-17.866].Conclusion: HR-HPV testing at the sixth month after cold-knife conization is an early and sensitive indicator for monitoring postoperative residuals or relapse of the lesion.Close surveillance of HR-HPV-positive patients and conventional monitoring of HR-HPV negative patients will not increase the onset risk.Furthermore, the positive margin is an important dangerous factor for residual or recurrent disease. 【总页数】4页(906-909)
【关键词】高危型人乳头瘤病毒;宫颈上皮内瘤变;冷刀锥切术;病变残留或复发 【作者】何善阳;袁力;李小利;游泽山;姚书忠
【作者单位】中山大学附属第一医院妇产科,广州市510080;中山大学附属第一医院妇产科,广州市510080;广州市番禺区何贤纪念医院;中山大学附属第一医院妇产科,广州市510080;中山大学附属第一医院妇产科,广州市510080 【正文语种】中文 【中图分类】 【文献来源】
https://www.zhangqiaokeyan.com/academic-journal-cn_chinese-journal-clinical-oncology_thesis/0201236919162.html 【相关文献】
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HR-HPV对CIN冷刀锥切后的随访价值
