细胞DNA倍体分析在宫颈不典型宫颈鳞状细胞诊断和预测中的价值

Diagnostic value of nuclear DNA ploidy analysis in atypical squamous cells of undeter-mined significance

目的:评价细胞DNA倍体分析法用于诊断和预测不典型宫颈鳞状细胞(ASCUS)的价值,为ASCUS病例探索一种敏感的、客观的筛查方法。方法:选取204例液基薄层细胞学诊断为ASCUS的病例样本,每例样本均行宫颈脱落细胞核DNA倍体分析和阴道镜下宫颈活检,比较细胞DNA倍体分析结果和组织学检查结果,计算DNA倍体分析方法的敏感性、特异性和阳性预测值,DNA倍体分析阳性病例以>5C细胞或有异倍体细胞峰出现为活检标准分组,比较活检组与非活检组间的CIN检出率。结果:若以筛查CIN及以上病变为目的,DNA倍体方法的灵敏度为68.93%(71/103),特异度为47.52%(48/101),阳性预测值为57.26%(71/124),阴性预测值为60.00%(48/80);若以筛查CINⅡ及以上病变为目的,DNA倍体分析方法的灵敏度为90.0%(18/20),特异度为43.49%(78/184),阳性预测值为14.52%(18/124),阴性预测值为97.50%(78/80)。活检组和非活检组CIN及以上病变检出率分别为79.07%及7.89%,活检组中CINⅡ及以上病变的检出率为100%,两组的差异有统计学意义(χ2=54.55,P=0.000)。结论:DNA倍体分析为筛查ASCUS病例提供了一种客观的、较为敏感的方法,有利于ASCUS病例中CIN的诊断。

Objective：To appraise diagnostic value of nuclear DNA ploidy analysis in atypical squamous cells of undeter-mined significance（ASCUS） and explore a sensitive and objective screening method for ASCUS.Methods：Selected 204 cases of ThinPrep cytology cases diagnosed as ASCUS samples,each sample was underwent cervical nuclear DNA ploidy analysis and colposcopy and biopsy for histopathological examination.The results of nuclear DNA ploidy analysis were compared with histology results to calculate the sensitivity and specificity and the positive predictive value of it.Positive cases of nuclear DNA ploidy analysis was grouped by detection of more than 5C cell or heterploid cells peak,detection rates of CIN in the biopsy group which include more than 5C cell or heterploid cell peak was compared with the other group which include less than 5C cell or euploid cell peak.Results：By nuclear DNA ploidy analysis,the sensitivity of 68.93% and specificity of 47.52% and positive predictive value of 57.26% and predictive value of the negative test 60.00% were calculated for cases of CINⅠ or above,while the sensitivity of 90.0% and specificity of 42.39% and positive predictive value of 14.52% and predictive value of the negative test 97.50% for cases of CINⅡ or above.In the positive cases by DNA ploidy analysis,detection rates of CINⅠ or above were 79.07% in the biopsy group,and the other were 7.89%,the detection rates of CINⅡ or above were 100% in the biopsy group,rates of CIN between the two groups was significant statistical difference（χ2=54.55,P=0.000）.Conclusion：Nuclear DNA ploidy analysis is a objective andmore sensitive screening method tand it is helpful to the early prediction and diagnosis of the atypical squamous cells of undeter-mined significance（ASCUS）.