不能明确意义的不典型鳞状细胞伴DNA倍体异常在宫预早期病变筛查中的意义

Diagnostic implications of atypical squamous cells of unknown significance with abnormal DNA ploidy for early cervical lesions

目的 通过DNA定量分析与薄层液基细胞学检查,探讨不能明确意义的不典型鳞状细胞（ASCUS）伴DNA倍体异常在宫颈早期病变筛查中的意义.方法 对8448例患者进行DNA定量分析和液基细胞学检查,对1041例检出DNA倍体异常和（或）液基细胞学异常者进行宫颈组织学活检,分析其中247例ASCUS伴DNA倍体异常患者的组织学诊断情况.结果 （1）在8448例标本中,正常或良性细胞学7877例,ASCUS 426例,不除外高级别鳞状上皮内瘤变的不典型鳞状细胞（ASC-H）45例,低级别鳞状上皮内瘤变（LSIL） 55例,高级别鳞状上皮内瘤变（HSIL） 22例,其中伴1～2个DNA异倍体细胞者所占比例分别为5.6％（443/7877）、15.3％（65/426）、11.1％ （5/45）、9.1％ （5/55）、0（0/22）;伴≥3个异倍体细胞者所占比例分别为1.0％（77/7877）、39.0％ （166/426）、75.6％ （34/45）、76.4％ （42/55）、95.5％ （21/22）.（2）247例ASCUS患者在阴道镜下进行宫颈活检,宫颈上皮内瘤变（CIN）2及以上病变者67例;伴]～2个DNA异倍体细胞者36例,其中5例（13.9％,5/36）为CIN 2及以上病变;伴≥3个异倍体细胞者123例,其中56例（45.5％,56/123）为CIN 2及以上病变;DNA倍体正常者88例,其中6例（6.8％,6/88）为CIN 2及以上病变.ASCUS中伴]～2个DNA异倍体细胞组与伴≥3个异倍体细胞组比较,差异有统计学意义（X2=11.79,P＜0.01）;与DNA倍体正常组比较,差异无统计学意义（P＞0.05）.结论 ASCUS伴≥3个异倍体细胞者患CIN 2及以上病变的风险更高.DNA定量分析与薄层液基细胞学检查两者联合检测可为分流ASCUS患者、指导临床随访和治疗提供帮助.

Objective To investigate the clinical significance of atypical squamous cells of unknown significance （ASCUS） with abnormal DNA ploidy in the early diagnosis of cervical lesions.Methods Eight thousand four hundred and forty-eight patients were included in this study and all had DNA quantitative analysis and cervical liquid-based cytology.Among 1041 cases with DNA aneuploidy and/or abnormal cervical liquid-based cytology and additional cervical biopsy,histological review was performed in 247 ASCUS cases with abnormal DNA ploidy.Results （1） Among 8448 cases,7877 were normal or benign,426 were ASCUS,45 were ASC-H,55 were LSIL and 22 were HSIL by TBS diagnosis.The presence of 1-2 abnormal DNA ploidy cells was detected in 15.3% （65/426） of ASCUS,11.1% （5/45） of ASC-H,9.1% （5/55） of LSIL,and 0 （0/22） of HSIL.The presence of ≥ 3 abnormal DNA ploidy cells was detected in 39.0% （166/426） of ASCUS,75.6% （34/45） of ASC-H,76.4% （42/55） of LSIL,and 95.5% （21/22） of HSIL.（2） A total of 67 cases of CIN 2,CIN 3 or cancers were found in 247 patients with ASCUS by colposcopy biopsies,of which 13.9% （5/36） had 1-2 abnormal DNA ploidy cells,45.5% （56/123） had ≥3 abnormal DNA ploidy cells and 6.8% （6/88） had normal DNA polidy.ASCUS with 1-2 abnormal DNA ploidy cells and with ≥ 3 abnormal DNA ploidy cells were compared.The difference was statistically significant （x2 =11.79,P 〈0.01）.But the difference between ASCUS with 1-2 abnormal DNA ploidy cells and normal DNA ploidy had no statistical significance （P 〉 0.05）.Conclusions ASCUS with ≥3 abnormal DNA ploidy cells has higher risk for developing CIN 2,CIN 3 or invasive carcinoma.The application of DNA quantitative analysis and cervical liquid-based cytology test can help in guiding clinical follow-up and treatment options in patients with ASCUS.