DNA定量分析和高危型HPV-DNA检测在ASCUS分流诊断中的意义

Significance of DNA Quantitative Cytology and High-risk HPV-DNA Test in ASCUS Triage Diagnosis

目的探讨细胞DNA定量分析和高危型HPV-DNA定量检测在未明确意义非典型鳞状上皮细胞(atypical squamous cells of undetermined signification,ASCUS)诊断分流中的意义。方法 DNA定量分析组:193例行DNA定量分析;高危型HPV-DNA检测组:134例行高危型HPV-DNA检测。巴氏(the Bethesda system,TBS)系统诊断为ASCUS的327例患者均行阴道镜检及镜下活检。结果 327例ASCUS中,阴道镜活检病理诊断为炎症者204例(62.39%),CINⅠ70例(21.41%),CINⅡ13例(3.98%),CINⅢ30例(9.17%),宫颈癌10例(3.05%)。高危型HPV-DNA检测组和DNA定量分析组之间阴道镜活检病理检查结果比较差异无统计学意义。DNA定量分析和HPV-DNA检测预测CINⅡ及以上的阴性预测值分别为98.93%和94.74%。每100个被测细胞数中异倍体细胞不同百分比比较,<0.1%和≥0.1%的阴道镜活检结果差异有统计学意义。≥3个DNA异倍体预测CINⅡ及以上病理改变,其敏感度、特异性、阳性预测值、阴性预测值分别为80.64%、47.06%、40.99%、84.21%。结论 DNA定量分析和高危型HPV-DNA检测可用于ASCUS的分流,但DNA定量分析更经济。

Objective To explore the significance of DNA quantitative cytology and High-risk HPV-DNA testing in ASCUS riage diagnosis. Methods The DNA quantitative cytology group included 193 cases and the high-risk HPV-DNA comprises 134 cases. ASCUS diagnosed by TBS undergone with automatic cell turnout check analysis system or High-risk HPV-DNA test later, were both done colposcopy directed biopsy soon. There was a comparison between these two cases in pathological results. Results Of the 327 ASCUS cases, 204 cases were histologically diagnosed as inflammation （62. 39%）, 70 cases were CIN I （21.41%）, 13 cases were CINⅡ（3. 98%）, 30 cases were CIN Ⅲ （9. 17%）,and 10 cases were cervical invasive cancer （3.05 %）. The histological diagnosis were no statistical distinction between HR- HPV-DNA and DNA Quantitative cytology groups. The negative predictive values of HPV-DNA and DNA Quantitative cytology were 94. 74% and 98. 93%, respectively. Compared with the percentage of DNA amount greater than 5C （DNA Index〉2. 5） cells, the histological diagnosis were significantly dif-ferent between 〈0. 1% and ≥0. 10/60 . DNA heteroploid more than or equal to three were used to predict CIN II or more severe pathological changes, and its sensitivity, specificity, positive predictive values and negative predictive values were 80. 64%, 47. 06%, 40. 99%, 84. 21 %, respectively. Conclusion DNA Quantitative cytology and High-risk HPV-DNA test can be used for ASCUS triage , but the cost of DNA Quantitative cytology is cheaper than High-risk HPV-DNA test.