液基细胞学与分子病理学对宫颈癌及癌前病变筛查的意义探讨  

The Significance of Liquid-based Cytology and Molecular Pathology in the Screening of Cervical Cancer and Precancerous Lesions

作　　者：王旭波[1] 张培影[1] 徐侠[1] 杨海燕[1] 杨静[1] 王为[1] 

机构地区：[1]南京中医药大学附属医院徐州市中医院,江苏徐州221003

出　　处：《辽宁中医杂志》2010年第3期387-389,共3页Liaoning Journal of Traditional Chinese Medicine

基　　金：江苏省中医药局科研课题(HZ07099)

摘　　要：目的:探讨液基薄层细胞学检查(TCT)和分子病理学检测宫颈HPV高危型(16/18型)感染对宫颈癌及癌前病变筛查的价值,评价原位杂交技术对宫颈癌前病变诊断和判断预后的意义。方法:采用液基细胞学检查和原位杂交检测方法对妇科门诊和住院的3876例女性患者,进行宫颈液基细胞学检查和高危型HPV DNA检测,判定液基细胞学检查和高危型HPV感染与宫颈癌及癌前病变的相关性,以宫颈活检的组织病理学结果为确诊标准。结果:3876例患者均行液基薄层细胞学检查,患病率6.11%(237/3876例,低度病变以上),其中,LSIL2.71%(105/3876例),HSIL2.92%(113/3876例),SCC0.49%(19/3876例)。218例患者HPV-DNA16/18检出率为47.25%(103/218例),其中CINⅠ16.67%(15/90例)、CINⅡ48.43%(31/64例)、CINⅢ91.11%、(41/45例)、SCC84.21%(16/19例);CINⅠ、Ⅱ、Ⅲ与SCC之间HPV感染率有显著性差异(P<0.01)。结论:TCT检测宫颈病变客观、准确,HPV-DNA16/18型对宫颈癌及癌前病变的诊断特异度、敏感度提高;二者协同使用对宫颈癌的筛查具有早期、敏感、特异的特点,为宫颈癌及癌前病变早期干预提供了实验室依据,此方法具有较高的临床使用价值和推广前景。Objective：To explore the diagnostic value of the thin liquid-based cytology and molecular pathology detection for cervical high-risk HPV（16/18 type）in the screening of cervical cancer and precancerous lesions.Methods：Giving the cervical cytology test and high-risk HPV DNA detection to 3,876 female cases of out-patient and inpatient in gynecological department of hospital in order to determine the relationship between the high-risk HPV infection and the cervical cancer as well as the precancerous lesions by the liquid-based cytology（TCT）and in situ hybridization detection,with the histopathological result of cervical biopsy as the final diagnosis standard.Results：In the 3,876 cases with thin liquid-based cytology Test（TCT）,the prevalence rate is 6.11%（237/3876 cases,low-grade lesions above）,including 105 cases of low-grade squamous intraepithelial neoplasia（LSIL）（2.71%）,113 cases of high-grade squamous intraepithelial neoplasia （HSIL）（2.92%）and 19 cases of cervical cancer（SCC）（0.49%）.And the positive rate of HPV-DNA16/18（103/218 cases） is as follows：CIN I 16.67%（15/90 cases）,CIN II 48.43% （31/64 cases,CIN III 91.11%（41/45 cases）,SCC 84.21%（16/19 cases）.There is a significant difference of HPV infection rate between CIN I、II、III and SCC（P0.01）.Conclusion：The detection of cervical lesions by TCT is objective and accurate.And the in situ hybridization HPV-DNA16/18 detection of cervical cancer and precancerous lesions is early,sensitive and specific.It shows a high clinical value in improving the specificity and sensitivity of cervicalcancer early screening to use them synergistically.

关 键 词：宫颈癌 人乳头瘤病毒(HPV) 分子病理学 原位杂交(ISH) 液基细胞学(TCT) 

分 类 号：R737.33[医药卫生—肿瘤]