细胞DNA倍体分析与常规细胞学诊断对宫颈上皮内瘤变诊断评估的比较  

A compared study on cervical intraepithelial lesion screening by DNA image cytometry and conventional cytology

作　　者：童华[1] 王祝鸣[2] 申艳[1] 阚延静[1] 李凤山[3] 

机构地区：[1]南京医科大学附属南京妇幼保健院妇产科,210004 [2]南京医科大学卫生部抗体研究中心 [3]南京医科大学附属南京妇幼保健院病理科,210004

出　　处：《中华临床医师杂志（电子版）》2009年第1期28-32,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的评价采用DNA定量分析方法进行宫颈癌普查的工作效率和准确性。方法对参与宫颈癌普查的3070名妇女用宫颈刷取材,进行液基薄层制片,分别进行巴氏染色和Feulgen染色,由细胞学医师对巴氏染色片做常规细胞学诊断,应用全自动DNA倍体分析对Feulgen染色片进行自动扫描诊断。结果对常规细胞检查结果在不明意义的非典型鳞状上皮(ASCUS)及以上病例和全自动DNA倍体分析系统检查可见异倍体细胞或异倍体细胞峰的病例,建议进一步做阴道镜检查以及宫颈活检。146名妇女做了病理活检。以病理诊断结果为标准,计算常规细胞学诊断和细胞DNA定量分析方法在筛查CINⅡ及以上宫颈病变的敏感性、特异性、阳性预测值、阴性预测值。以>3个DNA异倍体作为评估CINⅡ及以上病理改变,其敏感性、特异性、阳性预测值、阴性预测值分别是80.95%、57.60%、24.29%、57.60%,除阴性预测值外均比常规细胞检查为低级别鳞状上皮内病变及以上级别评估CINⅡ及以上病理改变标准(分别是76.19%、40.00%、17.58%、90.90%)要高,其他级别中<3个DNA异倍体与AS-CUS、≥10个DNA异倍体与高级别鳞状上皮内病变相应指标比较均高。同时,细胞DNA定量分析图客观准确,不仅能识别宫颈细胞涂片中的大量DNA异倍体,还能识别少量DNA异倍体细胞,对临床工作的指导有较重要的意义。结论细胞DNA定量分析方法能较好地提高宫颈癌普查的阳性检出率。Objective To increase the sensitivity and working efficiency of cervical cancer screening by using DNA quantitative cytology. Methods A total of 3 070 women were involved in this study. Cervical samples were taken by a cervical brush. Monolayer of cells were deposited onto microscopic slides by liquid-based sampling preparation. Two slides were prepared from each case： one slide was stained by Papanicolaou stain for conventional cytology examination, while the other slide wasstained by Feulgen method for determination of amount of DNA using an automated DNA imaging cytometry. Results All cases of ASCUS and cancer decided by conventional cytology and all cases with DNA amount greater than 5C （ DNA Index 〉 2. 5 ） ceils decided hy automated DNA imaging cytometry were sent to colposcopy and biopsy. A total of 146 women were followed hy colposcopic examination, where biopsies were taken. The sensitivity, specificity, positive predictive value and negative predictive value of DNA quantitative cytology（ DNA ploid 〉 3） and conventional cytology in screening CIN Ⅱ or sever lesions were 80. 95% and 76. 19% ,57.60% and 40. 00% ,24. 29% and 17. 58% ,57.60% and 90. 90%. The rusults of DNA quantitative cytology are higher than conventional cytology except negative predictive value. In cases of DNA quantitative cytology（ DNA ploid 〈 3） and conventional cytology in screening ASCUS or DNA quantitative cytology （ DNA ploid ≥ 10） and Conventional cytology in screening HSIL, the rusuhs of DNA quantitative cytology are all higher than The screening for cervical cancer by DNA quantitative cytology be conventional cytology. Conclusions Higher sensitivity under certain specificity.

关 键 词：宫颈上皮内瘤样病变 细胞学技术 全自动DNA倍体分析 

分 类 号：R737.33[医药卫生—肿瘤]