宫颈液基细胞学与DNA倍体分析诊断宫颈鳞状上皮内病变的准确性

Diagnostic accuracies of DNA-ICM and LBC for cervical squomous intraepithial lesions

目的探讨用DNA倍体分析(DNA-ICM)和宫颈液基细胞学(LBC)诊断宫颈鳞状上皮内病变的准确性。方法选取组织学诊断的鳞状上皮内病变或宫颈癌病例中LBC和/或DNA-ICM结果异常的病例,进行组织学与LBC和/或DNA-ICM结果对比。LBC诊断以非典型鳞状细胞-意义不明确(ASC-US)/非典型腺细胞(AGC)为切入点;DNA-ICM以≥3个细胞、DNA指数≥2.5为切入点;以组织学诊断结果为金标准,应用SAS V8数据分析。结果DNA-ICM与LBC对宫颈上皮内瘤变(CIN)筛查的敏感性,分别为84.9%和79.5%(P>0.05);两种方法结合筛查敏感性可达97.5%,高于独立应用一种方法的敏感性。188例同时进行了LBC和DNA-ICM检测的病例中,DNA-ICM阳性176例,其中组织学诊断炎性病变52例,CIN、阴道上皮内瘤变(VIN)和宫颈癌121例,其他类型病变3例;在组织学诊断为炎性病变的病例中LBC阳性率为46.2%,在CIN、VIN和宫颈癌的病例中阳性率为72.7%(P<0.01)。LBC诊断ASC-US的52例中,组织学最终诊断炎性病变20例,CIN 32例;DNA-ICM在炎性病变和CIN病例的阳性率分别为75%(15/20)和96.9%(31/32)(P<0.05)。结论 DNA-ICM具有和LBC相似的筛查敏感性,两种方法相结合敏感性可显著提高;LBC可协助分流DNA-ICM的假阳性病例,提高DNA-ICM的特异性;DNA-ICM有利于鉴别LBC的不确定诊断。

Objective To explore the accuracies of DNA image cytometry （DNA-ICM） and liquid-based cytology （LBC） in screening squomous intraepithial lesions. Methods The cases diagnosed by histology as cervical squamous intraepithelial lesions or cancer were selected to be compared with their LBC and/or DNA-ICM diagnoses, meanwhile the cases with positive LBC and DNA-ICM were selected to be compared with their histological diagnoses. The diagnoses of histology were taken as a golden standard. ASC-US/AGC and 3 or more cells with DNA index I〉2.5 were taken as a cut point for LBC and DNA-ICM, respectively. The data were analyzed by SAS V8 software. Results DNA-ICM and LBC revealed overall sensitivities of 84.9% and 79. 5%, respectively （ P 〉 0. 05 ）. Combination of 2 tests would yield a superior sensitivity of 97.5% compared with LBC （P 〈0. 01 ） and DNA-ICM （P 〈0. 01 ）. There were 188 cases with results from 2 tests. For the 176 cases with positive DNA-ICM （52 inflammatory lesions, 121 cervical intraepithelial neoplasia, vaginal intraepithelial neoplasia and cervical cancers）, the positive rate of LBC was 46.2% in inflammatory lesions and 72.7% in cervical intraepithelial neoplasia （ CIN）, vaginal intraepithelial neoplasia （ VIN ） and cervical cancers （P 〈 0. 05）. There were 52 cases of ASC-US diagnosed by LBC （20 inflammatory lesions and 32 CIN）, the positive rate of DNA-ICM was 75% in inflammatory lesions and 96.9% in CIN （ P 〈 0.05 ）. Conclusion The sensitivity of DNA-1CM is similar to that of LBC. Combination of DNA-ICM and LBC shows an improvement in the sensitivity compared to any single test alone. LBC is benefit for DNA-ICM to distinguish the false positive cases. DNA-ICM has the ability to clarify equivocal cytologic diagnoses.