DNA倍体分析在ASCUS分流诊断中的意义

Significance of DNA ploidy analysis in diagnosis of ASCUS

目的探讨DNA倍体分析在未明确诊断意义的不典型鳞状上皮细胞（ASCUS）分流诊断中的意义。方法对2009年1月至2011年7月在湖北省妇幼保健院进行宫颈分泌物液基薄层细胞学检查（TCT）诊断为ASCUS的875例患者进行DNA倍体分析；其中294例同时进行了高危型HPV（HR—HPV）检测；全部受检者均在月经干净第3—10天内行电子阴道镜下宫颈活检进行诊断对照。结果875例TCT结果为ASCUS者阴道镜活检病理检查结果分别为：慢性宫颈炎553例（63．2％），宫颈上皮内瘤变（CIN）I165例（18．9％），CINII45例（5．1％），CIND179例（9．0％），宫颈癌33例（3．8％）。DNA倍体分析中可见DNA异倍体细胞者532例（DNA异倍体细胞阳性），未见DNA异倍体细胞者343例（DNA异倍体细胞阴性）；DNA异倍体细胞阴性、异倍体细胞≥3个用于筛查CIN11及以上病变的敏感度、特异度、阳性预测值、阴性预测值分别为98．7％和90．3％、47．5％和46．1％、29．1％和40．8％、99．4％和92．1％。DNA异倍体细胞阳性的慢性宫颈炎、CINI、CIN11、CINIII和宫颈癌组织每100个被测细胞中，出现细胞核DNA含量（DI）〉1．25的细胞（〉2．5C细胞）数分别为（2．53±1．99）、（2．24±1．69）、（4．10±1．91）、（7．97±7．33）、（8．99±7．33）个；出现DI〉2．5的细胞（〉5c细胞）数分别为（0．10±O．07）、（0．20±0．11）、（0．28±0．19）、（1．27±1．23）、（0．36±0．33）个，慢性宫颈炎与CINI及CINm与宫颈癌患者DI〉1．25、〉2．5的细胞数分别比较，差异无统计学意义（P〉0．05），但慢性宫颈炎及CINI、CINⅢ及宫颈癌患者DI〉1．25、〉2．5的细胞数与CINⅡ分别比较，差异均有统计学意义（P〈0．05）。行HR—HPV检测的294例患者中，HR—HPV阳性216例，HR-HPV阴性78例；HR—HPV阳性及阴性患者中，异倍体细胞阴性、异倍体细胞〈3个或≥3个者，阴道镜活检结果比较，差异有统计学意义（x2=115．2775，P〈0．01）。结论DNA倍体分析可辅助用于ASCUS的分流诊断，从而避免过多的阴道镜活检，同时减少CIN和宫颈癌的漏诊。

Objective To investigate the significance of DNA ploidy analysis in diagnosis of atypical squamous cell of undetermined significance （ ASCUS）. Methods From Jan. 2009 to Jul. 2011, 875 women with ASCUS confirmed by liquid based thin layer cytology technique underwent DNA ploid analysis in Hubei Maternal and Child Health Hospital. Among 294 women underwent high risk HPV detection. All subjective were examined colposcopy directed biopsy at day 3 to 10 after menstruation. Results Among 875 ASCUS cases, 553 cases with histologically as chronic cervicitis （63.2%）, 165 cases with cervical intraepithelial neoplasia （CIN） I （18.9%）, 45 cases with CIN I1 （5.1%）, 79 cases with CIN 11I（9.0% ） and 33 cases with cervical invasive cancer （3.8%） were confirmed by colposcopy. Totally 532 cases were observed with DNA heteroploid, and 343 were not observed with DNA heteroploid. When DNA heterop｜oid negative and more than or equal to three ploid were used to predict CIN Ⅱ or more severe cervical diseases, the sensitivity, specificity, positive predictive values and negative predictive values were 98.7% and 90. 3% , 47.5% and 46. 1% , 29.1% and 40.8% , 99.4% and 92. 1% , respectively. The amount of heteroploid cells 〉2. 5c and 〉 5c among every 100 detected cells in chronic cervicitis and CIN I , CIN Ⅱ , CIN Ⅲ and cervix cancer were respectively 2. 53 ± 1.99 and 0. 10 ± 0. 07,2.24 ± 1.69 and 0.20±0. ll,4. 10±l.91 and 0. 28±0. 19,7.97 ±7.33 and 1.27 ±1.23,8.99 ±7.33 and 0.36 ＋0.33, there was no statistical difference in amount of heteropolid cells between 〉2. 5c and 〉 5c at group of chroniccervicitis and CIN I , CIN Ⅲ and cervix cancer 〉2. 5c and 〉 5c at group of chronic cervicitis, （ P 〉 0. 05 ）. However, the amount of heteroploid cells at CIN I , CIN Ⅱ and cervical were higher than that of CIN Ⅱ significantly （P 〈0. 05）. Among 294 cases with high risk （HR） HPV detection, 216 cases were HR-HPV positive, and 78 eases were HR-HPV negative. The pathology result by colposcopy at group of negative heteroploid, heteroploid 〈 3, or ≥3 showed statistical distribution （X2 = 115. 2775,P 〈0. 01）. Conclusion DNA ploidy analysis can be used for ASCUS diagnosis ,which can avoid excessive biopsy under colposcopy, in the mean time, CIN and cervical cancer could decrease missed diagnosis.