DNA倍体定量分析在宫颈上皮内瘤变及癌变细胞学筛查中的意义  

Diagnostic value of quantitative DNA ploidy analysis in cytological screening of cervical intraepithelial neoplasia and canceration

作　　者：陈威[1] 谭敏华[1] 周泳健 黄文彦 李玲[1] 安建虹 申洪[3] CHEN Wei;TAN Minhua;ZHOU Yongjian;HUANG Wenyan;LI Ling;AN Jianhong;SHEN Hong(Department of Pathology,First People’s Hospital of Zhaoqing,Zhaoqing 526060,China;School of Medicine,South China University of Technology,Guangzhou 510060,China;Department of Pathology,School of Basic Medical Science,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]肇庆市第一人民医院病理科,肇庆526060 [2]华南理工大学医学院,广州510060 [3]南方医科大学基础医学院病理学系,广州510515

出　　处：《中国体视学与图像分析》2021年第4期355-362,共8页Chinese Journal of Stereology and Image Analysis

基　　金：肇庆市科技创新指导类项目(201904031417);广州市科技计划项目(201300000192)。

摘　　要：目的评价宫颈细胞DNA倍体定量分析在宫颈上皮内瘤变(CIN)及癌变筛查中的价值。方法以宫颈病理活检确诊为金标准,对1113例宫颈DNA倍体定量分析结果进行诊断试验评价。结果异倍体(+),包括(1+)和(2+),共863例;其中病理组织学确诊为宫颈上皮内瘤变和癌变的病例共377例,包括CINⅠ127例,CINⅡ和Ⅲ229例,癌21例;其余486例为阴性。异倍体(-)共250例,其中病理组织学确诊为阴性(非宫颈上皮内瘤变及宫颈癌变)有232例,CINⅠ16例,CINⅡ和Ⅲ2例,宫颈癌0例。异倍体(+)筛查CIN及癌的灵敏度、特异度、标准化准确度、标准化阳性预告值和标准化阴性预告值分别为95.4%、32.3%、63.9%、58.5%和87.5%;筛查CINⅡ、Ⅲ及癌时分别为99.2%、28.8%、64.0%、58.2%和97.3%;单纯筛查宫颈癌时分别为100%、22.9%、61.5%、56.5%和100%。异倍体(2+)筛查CIN及癌时分别为77.2%、87.5%、82.4%、86.1%和79.3%;筛查CINⅡ、Ⅲ及癌时分别为90.1%、80.5%、85.3%、82.2%和89.0%;筛查宫颈癌时分别为90.5%、65.5%、78.1%、72.5%和87.4%。结论以DNA异倍体(+)筛查CIN、CINⅡ+Ⅲ及宫颈癌的灵敏度很高,特异度低,能有效筛查宫颈癌和宫颈高级别上皮内瘤变,不易漏诊,但确诊能力低;以DNA异倍体(2+)筛查CINⅡ、Ⅲ及癌的灵敏度高,特异度和准确度较高。Objective To scientifically evaluate the value of quantitative analysis of cervical cell DNA ploidy in screening of cervical intraepithelial neoplasia(CIN)and canceration.Methods Using cervical pathological biopsy as the gold standard,quantitative analysis results cervical DNA ploidy in 1113 caseswere evaluated by diagnostic test.Results There were 863 patients with alloploidy(+),including(1+)and(2+).377 cases were histologically diagnosed as cervical intraepithelial neoplasia and cervical cancer,including 127 cases of CINⅠ,229 cases of CINⅡandⅢ,and 21 cases of cervical cancer.The remaining 486 cases were negative.There were 250 cases of Heteroploid(-),of which 232 cases were pathologically negative(non cancer and cervical intraepithelial neoplasia),16 cases were CINⅠ,2 cases were CINⅡandⅢ,and no case of cerical cancer.The sensitivity,specificity,standardized accuracy,standardized positive predictive value and standardized negative predictive value of screening for CIN and cancer based on the aneuploidy(+)were 95.4%,32.3%,63.9%,58.5%and 87.5%,respectively.When screening for CINⅡ,Ⅲand carcinoma,the rates were 99.2%,28.8%,64.0%,58.2%,97.3%;When screening for the cervical cancer alone,the rates were 100%,22.9%,61.5%,56.5%and 100%,respectively.When screening for CIN and cancer,the rates were 77.2%,87.5%,82.4%,86.1%and 79.3%,respectively.When screening for CINⅡ,Ⅲand carcinoma,the rates were90.1%,80.5%,85.3%,82.2%,89.0%;When screening for cervical cancer,the rates were 90.5%,65.5%,78.1%,72.5%and 87.4%,respectively.Conclusions Quantitative DNA ploidy analysis using heteroploidy(+)has high sensitivity and low specificity for screening CIN,CINⅡ+Ⅲand cervical cancer.It can effectively screen for cervical cancer and high-grade intraepithelial neoplasia of the cervix with high sensitivity but low specificity.Quantitative DNA ploidy analysis with heteroploidy(2+)has high sensitivity,relatively high specificity and accuracy for screening CIN,CINⅡ+Ⅲand cervical cancer.

关 键 词：DNA倍体 CIN 诊断试验评价 宫颈癌 筛查 

分 类 号：R737.33[医药卫生—肿瘤] N3[医药卫生—临床医学]