TCT检测、阴道镜及荧光原位杂交在子宫颈病变诊断中的作用

The diagnostic effect of detect methods of liquid based cytology,colposcope and fluorescence in situ hybridization in the cervix disease

目的比较液基细胞学检测(TCT法)、阴道镜检测及荧光原位杂交(FISH)方法对宫颈癌及癌前病变的诊断作用,并探讨其单独及联合检测对子宫颈病变诊断的临床意义。方法收集2007年11月至2009年2月苏州大学附属第三医院妇科115例宫颈脱落细胞标本,其中CIN患者54例、宫颈癌患者25例、正常对照组36例,上述标本均接受TCT液基细胞学检测及荧光原位杂交hTERC基因检测,其中CIN及宫颈癌患者接受阴道镜检查。结果 CINI、CINIⅠ/Ⅲ和宫颈癌患者行液基细胞学检查,宫颈癌诊断的敏感性、特异性及准确度分别为52.0%、100%和84.8%。阴道镜检查的敏感性、特异性及准确度分别为76.0%、94.4%和88.6%。FISH检测的敏感度、特异度及准确度分别为92.0%、72.2%和78.5%。在正常人、CINI、CINIⅠ/Ⅲ和宫颈癌患者宫颈脱落细胞hTERC基因扩增阳性表达率分别是2.8%、6.7%、35.9%和92.0%,组间差异具有统计学意义(P<0.05)。结论荧光原位杂交hTERC基因检测宫颈癌具有较高的敏感性,能与TCT法和阴道镜检测较高的特异性形成互补;hTERC基因扩增阳性表达率与组织学分级具有紧密的相关性,可作为宫颈病变组织损伤程度及预后的一个指标。

Objective Compare the diagnostic efficiency of cervical cancer and precancerous lesions between the liquid-based cytology test（TCT method）,Colposcopy detection and fluorescence in situ hybridization（FISH） method,To explore the clinical significance with individual and joint testing.Methods To collect 115 cytologic samples of cervix in the Third Affiliated Hospital of Suzhou University from November 2007 to February 2009,54 cases of CIN patients,25 cases of cervical cancer patients and 36 cases of health women.All the cytology samples were both detected by the method of TCT and the method of fluorescence in situ hybridization（FISH）.the CIN patients and cervical cancer patients accepted the colposcopy among the total.Results The sensitivity,specificity and accuracy to detect cervix uteri cancer were 52.0%,100% and 84.8% respectively by the method of liquid-based cytology.The sensitivity,specificity and accuracy were 72.0%,94.2% and 84.8% respectively by the method of Colposcopy detect.The sensitivity,specificity and accuracy were 92.0%,72.2% and 78.5% respectively by the method of FISH.The positive expression rate of hTERC gene in the normal,CINI patients,CINIⅠ/Ⅲ patients and cervix uteri cancer was 2.8%,6.7%,35.9% and 92.0%,there was a statistically significance between the groups（P0.05）.Conclusion There is a complementation between the detect of hTERC which with higher sensitivity and the detects of TCT and colposcopy which with higher specificity.There was a close correlation between amplification of hTERC and histological grade.The evidence of hTERC might serve as a prognostic indicator to measure the grade of lesion.