DNA倍体细胞检测与宫颈液基细胞学检查在宫颈病变筛查中的应用  

Application of DNA image cytometry compared with ThinPrep cytologic test in the screening of cervical lesions

作　　者：初虹[1] 余志英[1] 邢娟[1] 张小军 滕国召[1] CHU Hong;YU Zhi-ying;XING Juan;ZHANG Xiao-jun;TENG Guo-zhao(Department of Gynecology,the First Affiliated Hospital of Shenzhen University(Shenzhen Second People's Hospital),Shenzhen 518035,Guangdong,CHINA)

机构地区：[1]深圳大学第一附属医院(深圳市第二人民医院)妇科,广东深圳518035

出　　处：《海南医学》2020年第14期1836-1839,共4页Hainan Medical Journal

基　　金：广东省深圳市第二人民医院临床研究项目基金(编号:KS20190521002)。

摘　　要：目的对比DNA倍体细胞检测(DNA-ICM)与宫颈液基细胞学检查(TCT)在宫颈病变筛查中的优缺点。方法回顾性分析2016年1月至2017年4月在深圳市第二人民医院妇科门诊同时进行DNA-ICM和TCT筛查的12753例患者的临床资料,其中198例因两种筛查任一筛查结果阳性,或HPV高危分型(+),或HPV高危分型(-)但妇科检查宫颈有可疑病灶者,故行阴道镜下宫颈活检。病理结果按慢性炎症(单纯炎症、湿疣样变)、低度病变(LSIL:CINⅠ)、高度病变(HSIL:CINⅡ-Ⅲ)及宫颈癌进行划分。分析两种方法在不同病理分类的灵敏度和特异度的差异。结果(1)活检病理以慢性宫颈炎为阴性结果,以LSIL(CINI)及其以上级别病变为阳性结果,两种方法比较,DNA-ICM灵敏度为93.5%(87/93),优于TCT的灵敏度69.9%(65/93),差异有统计学意义(P<0.05);DNA-ICM特异度为20.0%(21/105),低于TCT的特异度35.2%(37/105),差异有统计学意义(P<0.05);(2)对不同病理分类进行分层分析,DNA-ICM在湿疣样变、LSIL和HSIL中的阳性率分别为87.5%(49/56)、90.2%(37/41)和95.8%(46/48),明显高于TCT的64.2%(36/56)、63.0%(26/41)和72.9%(35/48),差异均有统计学意义(P<0.05);而在单纯炎症及宫颈癌中,DNA-ICM的阳性率分别为71.4%(35/49)和100%(4/4),与TCT的65.3%(32/49)和100%(4/4)结果相近,差异均无统计学意义(P>0.05)。结论对LSIL及其以上级别病变,DNA-ICM较TCT的敏感度高,虽然特异度降低,但可结合其他检查以弥补;同时DNA-ICM对湿疣样变、LSIL、HSIL的阳性率明显高于TCT,而对于单纯炎症及宫颈癌的阳性率又不低于TCT,故DNA-ICM可作为比TCT更敏感的宫颈癌筛查方法。Objective To compare DNA image cytometry(DNA-ICM)with ThinPrep cytologic test(TCT)in the screening of cervical lesions.Methods The clinical data of 12753 outpatients,who were performed both DNA image cytometry(DNA-ICM)and ThinPrep cytologic test(TCT)from January 2016 to April 2017 in Department of Gynecology,the First Affiliated Hospital of Shenzhen University,were retrospectively analyzed.Among the patients,198 cases,who had positive DNA-ICM or TCT results,or HPV high risk classification(+),or HPV high risk classification(-)but with suspected cervical lesions in gynecological examination,underwent cervical biopsy on suspected lesions under colposcope.The pathological results were classified as chronic inflammation(single inflammation and condyloma-like lesions),low-grade squamous intraepithelial lesions(LSIL:cervical intraepithelial neoplasiaⅠ,CINⅠ),high-grade squamous intraepithelial lesions(CINⅡand CINⅢ)and cervical cancer.The sensitivity and specificity of DNA-ICM and TCT in different pathological classifications were analyzed.Results(1)When taking LSIL(CINⅠ),HSIL(CINⅡand CINⅢ),and cervical cancer as positive results,while chronic inflammation(single inflammation and condyloma-like lesions)as negative results,the sensitivity was 93.5%(87/93)of DNA-ICM versus 69.9%(65/93)of TCT,and the specificity was 20.0%(21/105)versus 35.2%(37/105)(all P<0.05).(2)Hierarchical analysis of different pathological classification showed that the positive rates of DNA-ICM in condyloma-like lesions,LSIL and HSIL were 87.5%(49/56),90.2%(37/41),95.8%(46/48),respectively,which were significantly higher than corresponding 64.2%(36/56),63.0%(26/41),and 72.9%(35/48)in TCT(all P<0.05).In single inflammation and cervical cancer,the positive rates were 71.4%(35/49)and 100.0%(4/4)of DNA-ICM versus 65.3%(32/49)and 100.0%(4/4)of TCT(all P>0.05).Conclusion In LSIL and HSIL,DNA-ICM is more sensitive but less reliable than TCT.Combining other methods should be considered to improve the specificity of DNA-ICM.Overall,the positive ra

关 键 词：DNA倍体细胞检测 DNA细胞计数成像 宫颈液基细胞学检查 低级别鳞状上皮内病变 高级别鳞状上皮内病变 宫颈癌 

分 类 号：R711.74[医药卫生—妇产科学]