细胞块免疫化学技术在宫颈癌前病变筛查中的应用价值  

Application of immunochemistry technique on cell blocks in screening of cervical precancerous lesion

作　　者：包磊[1] 任丽芳[1] 蔡红光[1] 杨惠英[1] 李美平[1] 鲁波[1] 

机构地区：[1]绍兴市妇幼保健院病理科,312000

出　　处：《浙江医学》2011年第12期1783-1786,共4页Zhejiang Medical Journal

基　　金：浙江省卫生厅科技成果重点推广计划（2009TG008）

摘　　要：目的 探讨细胞块免疫细胞化学技术在宫颈脱落细胞筛查宫颈癌中的应用价值.方法 以组织病理诊断结果为标准,对182例细胞学诊断为非典型鳞状上皮细胞（ASC）及以上病变的病例,利用宫颈液基细胞学残余标本制作细胞块,进行p16INK4a蛋白的免疫细胞化学染色.结果 p16INK4a蛋白在宫颈炎及低级别病变表达为41.37%（36/87）,高级别及癌中的表达95.78%（91/95）,差异有统计学意义（P＜0.01）.在细胞学诊断结果为ASC至鳞状细胞癌（SCC）中,p16INK4a蛋白阳性表达率与病变级别呈正相关,其差异有统计学意义（P＜0.01）.p16INK4a蛋白阳性表达对高级别宫颈病变诊断的敏感性为97.20%,特异性83.40%,阳性预测值92.12%,阴性预测值74.02%,诊断准确率92.37%.在宫颈病变的病例中细胞块与组织学标本中p16INK4a蛋白表达率分别为92.92%（105/113）和93.80%（106/113）,两者差异无统计学意义（P ＞0.05）.结论 细胞块技术对宫颈脱落细胞进行p16INK4a蛋白检测,可提高宫颈癌筛查的准确性,同时细胞块可长期保存,重复切片及进行多次检测,便于应用推广.Objective To evaluate the application of immunochemistry technique on ceil blocks in screening of cervical precancerous lesion. Methods The cell blocks were made from 182 remaining samples of cervical fluid, which were diagnosed as precancerous lesions or carcinoma of the cervix according to Bethesda System for Reporting Cervical Cytology. The expression of P16INK4a protein on cell blocks was detected by immunocytochemistry. Results The expression of P16INK4a protein in cervicitis/Iow-grade intraepithelial lesion, high-grade intraepithelial lesion/squamous cell carcinoma was 41.37% and 95.78% respectively （ X2=20.52, P〈0.01 ）. The expression of P16INK4a protein was positively correlated with lesion grades （ X 2=35.29, P〈0.01 ）. When the positive P16INK4a protein expression was used to diagnose high-grade cervical lesion, the sen- sitivity, specificity, positive predictive value, negative predictive value and accurate rate of diagnosis were 97.2%, 83.4%, 92.12%, 74.02% and 92.37%, respectively. The expressions of P16INK4a on cell blocks and histological specimens were 92.9% （105/113） and 93.8%（106/113）, respectively （P 〉0.05）. Conclusion The application of cell blocks made from remaining cervical cytological samples to detect P16INK4a protein expression can enhance the accurate rate of screening for cervical carcinoma.

关 键 词：细胞块 P16INK4A蛋白 免疫细胞化学 宫颈癌 筛查 

分 类 号：R737.33[医药卫生—肿瘤]