子宫颈脱落细胞块联合p16/Ki-67双染在意义不明确的非典型鳞状上皮细胞和低级别鳞状上皮内病变的筛查意义  

Significance of cervical exfoliated cell block and p16/Ki-67 dual-staining cytology in screening of ASC-US and LSIL Papanicolaou cytology

作　　者：张波 杨志敏 康子婧 康凯夫 许萍榕 邹倩 朱伟 王效军 ZHANG Bo;YANG Zhimin;KANG Zijing;KANG Kaifu;XU Pingrong;ZOU Qian;ZHU Wei;WANG Xiaojun(Department of Pathology,the Third Affiliated Hospital of Guangdong Medi-cal University(Longjiang Hospital,Shunde District,Foshan),Foshan 528000,China)

机构地区：[1]广东医科大学附属第三医院,佛山市顺德区龙江医院)病理科,广东佛山528000 [2]佛山市南海区第四人民医院病理科,广东佛山528000 [3]南方医科大学顺德医院,佛山市顺德区第一人民医院),广东佛山528000 [4]广东医科大学顺德妇女儿童医院,佛山市顺德区妇幼保健院),广东佛山528000 [5]广东医科大学病理学系病理学技术教研室,广东东莞523808 [6]广东医科大学公共卫生学院流行病与统计学系,广东东莞523808

出　　处：《实用医学杂志》2022年第22期2795-2800,共6页The Journal of Practical Medicine

基　　金：国家自然科学基金(编号:81472275);佛山市科学技术局医学类科技攻关项目(编号:2020001005507);广东省自然科学基金(编号:2020A1515010303,2022A1515012171)。

摘　　要：目的探讨子宫颈脱落细胞块(cell block,CB)中p16/Ki-67免疫细胞化学双染在LSIL的染色判读标准,比较CB联合p16/Ki-67双染对比HR-HPV检测在ASC-US和LSIL患者中的筛查意义。方法收集TCT诊断为ASC-US和LSIL同时行HR-HPV检测的患者标本共210例制备CB,以子宫颈活检诊断为最终标准,评价CB联合p16/Ki-67的筛查效能。结果(1)210例TCT样本制备的CB诊断结果为:NILM 16例、LSIL 171例及HSIL 23例;HPV阳性191例,HPV阴性19例;p16/Ki-67 NILM 57例、LSIL 140例及HSIL 13例。(2)在LSIL和ASC-US样本中,CB的敏感度为90.8%和93.5%,p16/Ki-67双染的特异度为100%和87.5%。(3)按照30岁进行年龄分组,CB和p16/Ki-67双染具有较好的敏感度(95%~100%)和特异度(80%~100%)。结论(1)本研究所采用的p16/Ki-67双染在LSIL的染色判读方法简易、可重复性强,结合细胞形态学能够有效进一步分流ASC-US病例。(2)CB具有较高的敏感度,CB联合p16/Ki-67双染具有较高敏感度和特异度,同时结合HR-HPV三者联合效果等同于活检。Objective To explore the staining interpretation standard of p16/Ki-67 immunocytochemical staining of cervical exfoliated cell block(CB)in low-grade squamous intraepithelial lesions(LSIL)and to compare the significance of CB combined with p16/Ki-67 dual-staining and HR-HPV in ASC-US and LSIL patients.Methods A total of 210 patients with ASC-US and LSIL diagnosed by TCT and HR-HPV detection were collected.The diagnosis of cervical biopsy was taken as the final standard,and the significance of CB combined with p16/Ki-67 dualstaining in ASC-US and LSIL patients was evaluated.Results(1)The CB diagnostic results of 210 TCT samples included NILM(16 cases),LSIL(171 cases)and HSIL(23 cases);HR-HPV positive(191 cases),HPV negative(19 cases);p16/Ki-67 NILM(57 cases),LSIL(140 cases)and HSIL(13 cases).(2)In cases diagnosed with LSIL and ASC-US,the sensitivity of CB was 90.8%and 93.5%,and the specificity of p16/Ki-67 was 100%and 87.5%,respectively.(3)Taking age 30 as stratification,CB and p16/Ki-67 dual-staining had better sensitivity(95%~100%)and specificity(80%~100%).Conclusions(1)The interpretation criteria of p16/Ki-67 dualstaining in LSIL is simple and reproducible,and it can effectively further shunt ASC-US cases when combined with cell morphology.(2)CB has higher sensitivity and it has higher sensitivity and specificity when combined with p16/Ki-67 dual-staining and the combined effect of CB,p16/Ki-67 and HR-HPV is equivalent to that of biopsy.

关 键 词：子宫颈细胞块 p16/Ki-67免疫细胞化学双染 染色判读 

分 类 号：R737.33[医药卫生—肿瘤]