三种常用宫颈癌检查方法比较  

Comparison of three methods for detection of cervix cancer

作　　者：仲娣[1] 李彬[1] 付芸 严姗 汪键 龚培尧[1] Zhong Di;Li Bin;Fu Yun;Yan Shan;Wang Jian;Gong Peiyao(Xuzhou Maternity and Child Health Care Hospital,Xuzhou 221009,China;Wuhan Landing Cloud Medical Laboratory,Wuhan 430206,China)

机构地区：[1]徐州市妇幼保健院,徐州221009 [2]武汉兰丁云医学检验实验室,武汉430206

出　　处：《中国组织化学与细胞化学杂志》2018年第5期476-480,486,共6页Chinese Journal of Histochemistry and Cytochemistry

摘　　要：目的比较常规细胞学、高危型HPV-DNA病毒测定及DNA倍体分析方法在诊断宫颈癌及癌前病变(cervical intraepithelial neoplasia, CIN)的优缺点。方法 374名妇女做宫颈活检前进行了宫颈细胞常规细胞学诊断、高危型HPV-DNA病毒测定和DNA倍体分析。用宫颈刷刷取宫颈细胞,每个样本制成二张液基薄层玻片,一张经巴氏染色用于常规细胞学诊断(TBS),另一张经Feulgen染色做DNA倍体分析,剩余样本做HC2-HPV-DNA检测。宫颈活检样本进行组织病理诊断。结果 374例宫颈活检样本中发现167例宫颈炎,92例CIN1,63例CIN2,37例CIN3和15例宫颈浸润癌。在259例宫颈炎和CIN1病例中,高危型HPV检测201例为阴性,58例为阳性;DNA倍体分析发现有异倍体细胞的病例为40例,219例为阴性;TBS诊断ASCUS及以上级别的病例30例,229例为正常。在115例CIN2、CIN3和宫颈浸润癌中,高危型HPV病毒测定阳性为98例,阴性为17例;DNA倍体分析阳性为93例,阴性为22例;TBS诊断ASCUS及以上级别的有79例,正常为36例。诊断CIN2及以上级别的敏感性、特异性、阳性预测值和阴性预测值,高危型HPV测定分别为85.2%、77.6%、62.8%和92.2%;DNA倍体分析分别为80%、84.6%、69.9%和90.9%;TBS诊断为68.7%、88.4%、72.5%和86.4%。结论在诊断宫颈高级别癌前病变(CIN2和CIN3)和宫颈癌上,HPV-DNA病毒方法敏感性高,特异性低;常规细胞学方法敏感性低,特异性高;DNA倍体分析方法正好介于二种方法之间。三种方法均有优缺点,具体运用应根据实际情况而定。Objective To compare the advantages and disadvantages of routine cytology,high-risk HPV DNA test and DNA ploidy analysis in the diagnosis of cervix cancer and cervical intraepithelial neoplasia(CIN).Methods 374 women underwent routine cervical cytology diagnosis,high-risk HPV-DNA virus test and DNA ploidy analysis before cervical biopsy.Each sample of cervical cells brushed with a cervical brush was made into two liquid-based thin slides,one of which was stained with Pap solution for conventional cytological diagnosis(TBS)and the other with Feplgen solution for DNA ploidy analysis.The remaining samples were used for HC2-HPV-DNA test.Then cervical biopsies were taken for histopathological diagnosis.Results 167 cervicitis,92 CIN1,63 CIN2,37 CIN3 and 15 invasion cervix cancer in 374 biopsies were diagnosed by pathology.In total of 259 cases of cervicitis and CIN1,201 negative and 58 positive were measured by HPV-DNA test;219 negative and 40 positive were detected by DNA ploidy analysis;30 abnormal and 229 normal were diagnosed by cytology.In total of 115 cases of CIN2,CIN3 and cancer,98 cases were positive while 17 cases were negative for high-risk HPV virus test;93 cases were positive while 22 cases were negative for DNA ploidy analysis;79 were diagnosed as ASCUS and above while 36 cases were normal for TBS.In cases diagnosed as CIN2 or above,sensitivity,specificity,positive and negative predictive values were determined as 85.2%,77.6%,62.8%and 92.2%by HC2-HPV-DNA test,80%,84.6%,69.9%and 90.9%with DNA ploidy analysis,68.7%,88.4%,72.5%and 86.4%by cytology.Conclusion In the diagnosis of high-grade cervical precancerous lesions(CIN2 and CIN3)and cervical cancer,HPV-DNA virus method has high sensitivity and low specificity;while routine cytology method has low sensitivity and high specificity.However,the sensitivity and specificity of DNA ploidy analysis method is just between the two methods above.Since all the three methods have advantages and disadvantages,the specific application should be based on actual condition

关 键 词：高危型HPV-DNA病毒 DNA倍体分析 常规细胞学 宫颈癌 

分 类 号：R361[医药卫生—病理学]