Objective: To investigate the human papillomavirus (HPV) positive rate and its usefulness in predicting CIN2+ in women with atypical squamous cells of undetermined significance (ASC-US) cervical cytology. Methods: A pooled analysis was conducted using published data of hospital classification, HPV positive rate and histopathologic diagnosis in ASC-US population during 2005 to 2017 from 104 studies which enrolled 28 923 ASC-US samples. Results: The overall HPV positive rate was 52.09% (range from 12.06% to 88.68%). The HPV positive rate in 79 tertiary hospitals of 21 244 cases was 52.46%, slightly higher than the 50.87% in 22 second-class hospitals of 6 925 cases. There was no significant difference between specialized hospitals and general hospitals. In addition, the positive rate of HC2 conducted in 66 hospitals with 19 791 cases was 53.13%, which was slightly higher than 51.10% of reverse hybridization from 24 hospitals with 6 338 cases. In 73 studies of 18 163 cases with histological diagnosis, the sensitivity of HPV for detecting CIN2+ was 90.16% (95%CI: 88.91% to 91.28%), specificity was 53.08% (95%CI: 53.02% to 54.57%), positive predictive value was 23.24% and negative predictive value was 97.24%. Conclusion: HPV detection is clinically validated for ASC-US triage, but there is a wide variation of HPV positive rate in population of cervical cytological diagnosis as ASC-US in China, suggesting different diagnostic level between regions and hospitals and further improvement is needed.
目的： 探讨人乳头状瘤病毒(human papillomavirus，HPV)检测在中国宫颈细胞学诊断为不能明确意义的不典型鳞状细胞(atypical squamous cells of undetermined significance，ASC-US)患者中的阳性率和对宫颈上皮内瘤变(CIN)2＋病例筛查效果的差异。 方法： 收集2005至2017年我国公开发表的104项报道中28 923例ASC-US患者就诊医院的等级、分类、地区分布、检测方法、HPV阳性率和宫颈病理诊断结果，分析HPV筛查CIN2＋的灵敏度及特异度。 结果： 28 923例患者HPV总阳性率为52.09%，104项研究中阳性率最低为12.06%，最高为88.68%。在三级医院进行的79项研究21 244例患者的HPV阳性率为52.46%，略高于在二级医院进行的22项研究6 925例患者的阳性率50.87%，而综合医院和专科医院的阳性率差异无统计学意义。此外，66项采用第二代杂交捕获技术检测的19 791例标本阳性率53.13%，略高于24项采用反向杂交技术检测的6 338例标本的阳性率51.10%。在73项18 163例有明确病理诊断结果的研究中，HPV检测筛查CIN2＋的灵敏度为90.16%(95%CI：88.91%～91.28%)，特异度为53.08%(95%CI：53.02%～54.57%)，阳性预测值为23.24%，阴性预测值为97.24%。 结论： HPV检测是ASC-US患者分流的有效方法，但不同医院患者HPV检测的阳性率变异范围较大，提示我国不同地区和医院间的诊断水平存在差异。.
Keywords: Atypical squamous cells of unknown significance; Cervix uteri; Cytological techniques.