The Clinical Significance Of Thinprep Cytologic Test(TCT) Combined With Human Papillomavirus (HPV) Subtypes Testing In The Diagnosis And Follow-Up Of Cervical Intraepithelial Neoplasia (CIN) And Cervical Squamous Cell Carcinoma (SCC)

Objective1. Detecting the distributive condition of twenty-one types of HPV subtypes in this studying group.2. Detecting the relationship between subtypes of HPV and CIN and cervical carcinoma, in this study .3. Detecting the clinical value of TCT combined with HPV subtypes testing in the diaganosis and follow-up of CIN.4. Detecting the clinical significance of TCT combined with HPV subtypes testing in the follow-up of cervical carcinoma.MethodsOne hundred and eighty patients with HPV-positive from 1309 patients by HPV subtypes testing were selected in this study,in gynecological department of Jinan Military General Hospital from January 2008 to November. 180 cases of HPV-positive patients were tested by TCT and histopathological examination, and were divided into control group(112 cases of cervicitis)and study groups(26 cases of CIN,27 cases of ceivical carcinoma,15 cases of cervical condyloma acuminate,6 cases of CIN,8 cases of CINⅡ,12 cases of CINⅢ)according to histopathological results. And they were tested by TCT combined with HPV subtypes testing after treatment for three, six, twelve months.Results 1. 180 patients with HPV-positive were selected from 1309 patients in this study. 150 cases with high-risk HPV(including the single high-risk HPV and multiple high-risk HPV)were selected,21 cases with low-risk HPV(including the single low-risk type HPV and multiple low-risk type HPV)were selected, 9 cases with high and low risk HPV subtypes were selected; 152 cases with single HPV subtypes were selected,28 cases with multiple HPV subtypes were selected(18 cases with double HPV subtypes, 6 cases with triple HPV subtypes,3 cases with fourth HPV subtypes,1 cases with seventh HPV subtypes). Multiple HPV subtypes infective rate was 15.6%. 19 types of HPV subtypes were selected from 21 types of HPV subtypes, in this study. HPV subtypes were selected:HPV16 subtype(43.9%),HPV52 subtype(15.6%),HPV11 subtype(10.0%),HPV58 subtype (8.9%),HPV31 subtype(7.8%),HPV33 subtype (7.2%). HPV42 subtypes and HPV 42 subtypes were not selected.2. The infective rate of high-risk HPV subtypes increased with cervical lesions aggravation,in the studying groups:The infective rate of high-risk HPV subtypes of control group,CIN group,cervical carcinoma group was 85.7%,92.3%, 100.0%. Compared cervical carcinoma group with control group,they had significant difference(P<0.05). Compared CIN group with control group,they had not significant difference(P>0.05). In CIN group,24 patients with high-risk HPV subtypes were selected and 1 patient with low-risk HPV subtypes was selected.Compared the infective rate of high-risk HPV subtypes(92.3%) with the infective rate of low-risk HPV subtypes(3.8%),they had significant difference (P<0.05). In cervical carcinoma group, 27 patients with high-risk HPV subtypes were selected and patient with low-risk HPV subtypes was not selected. CIN and cervical carcinoma caused by high-risk HPV subtypes were higher than low-risk HPV subtypes,in this study.3. The multiple HPV subtypes infective rates were different in the different cervical lesions:the multiple HPV subtypes infective rate of control group,CIN group,cervical carcinoma group was 8.9%,15.4%,25.9%. Compared cervical carcinoma group with control group, they had significant difference(P<0.05). Compared CIN group with control group,they had not significant difference(P﹥0.05). Cervical carcinoma were closely related to the multiple HPV subtypes,in this study. HPV genotypes were different in the different cervical lesions: In control group,HPV genotypes were mainly HPV16 subtype,HPV52 subtype,HPV31 subtype,HPV11 subtype; In CIN group,HPV genotypes were mainly HPV16 subtype,HPV33 subtype,HPV52 subtype,HPVCP8304 subtype;In cervical carcinoma group,HPV genotypes were mainly HPV16 subtype,HPV33 subtype, HPV58 subtype,HPV52 subtype;In cervical condyloma acuminata group,HPV genotypes were mainly HPV6 subtype,HPV11 subtype,HPV16 subtype,HPV52 subtype. So,different cervical lesions were caused by different HPV genotypes.4. The abnormal rate of TCT increased with cervical lesions aggravation,in this study:The abnormal rate of TCT of control group,CIN group,cervical carcinoma group was 30.4%,76.9%,96.3%. Compared cervical carcinoma group with control group,they had significant difference(P<0.05). Compared CIN group with control group,they had significant difference(P<0.05). The selective rate of CIN and cervical carcinoma was 54.7% in the patients with HPV-positive and abnormal TCT results,and it was 6.4% in the patients with HPV-positive and normal TCT results,compared the former with the latter,they had significant difference(P<0.05). So the selective rate of CIN and cervical carcinoma were increased by TCT combined with HPV subtypes testing.5. The HPV negative rates were different in different cervical lesions which were treated after 3 months: The HPV negative rate decreased with cervical lesions aggravation in CIN group,the HPV negative rates of CINⅠ, CINⅡ, CINⅢwere 100.0%,87.5%,83.3%. The HPV negative rate of control group was 87.1%. Compared CIN group with control group,they had not significant difference(P﹥0.05). After cervical carcinoma radical surgery 3 months,the HPV negative rate of cervical carcinoma was 88.2%. Compared cervical carcinoma group with control group,they had not significant difference(P﹥0.05). The HPV negative rates of cervical lesions were high after treatment,active treament of cervical lesion with HPV-positive was significant for prevention of cervical carcinoma. 9 patients with HPV-positive were selected from the follow-uping 74 patients(26 cases of CIN,17 cases of cervical carcinoma,31cases of cervicitis). 4 patients with HPV-positive had the same HPV genotype before treated and after treated, 5 patients with HPV-positive had the different HPV genotypes before treatment and after treatment. Patients with HPV-positive existed persistent HPV-positive with same HPV genotype and reinfective HPV-positive with different HPV genotype,in the follow–uping group.Conclusions1. HPV subtypes testing could judge the HPV genotypes and multiple HPV infection,and would predict disease outcome and provide the basis and comparison for follow-up of cervical lesion.2. Different cervical lesions were caused by different HPV subtypes, high-risk HPV infective rate increased with cervical lesions progress.3. The risk was different between multiple HPV subtypes with single HPV subtypes. Cervical carcinoma was closely related to multiple HPV subtypes, in this study.4. The abnormal rate of TCT increased with cervical lesions aggravation. The selective rate of CIN and cervical carcinoma were increased by TCT combined with HPV subtypes testing.5. The HPV negative rates of CIN and cervical carcinoma were high after treatment,active treament of cervical lesion with HPV-positive was significant for prevention of cervical carcinoma.6. Patients with HPV-positive existed persistent HPV-positive with same HPV genotype and reinfective HPV-positive with different HPV genotype,in the follow–up of cervical lesions.