hTERC和高危HPV及细胞学联合检测在宫颈癌筛查中的价值

Significance of Co-testing of Genomic Amplification of the Human Telomerase RNA Component Gene,High Risk Human Papilloma Virus Detection and Liquid-based Cytological Test for Cervical Cancer Screening

目的:探讨联合应用hTERC、高危HPV检测及液基细胞学检查TCT在宫颈癌筛查中的意义。方法:选择2010年5月至2012年1月因宫颈异常在佛山市妇幼保健院宫颈门诊行TCT检查的患者100例为研究对象,同时行HC2检测高危HPV感染,FISH技术检测hTERC基因扩增及阴道镜下病理活组织检查,以病理学结果为金标准,将三种检测方法的结果与其进行比较。结果:非CIN组、CIN1、高级别CIN及浸润癌中TCT检查与病理学结果符合率分别为88.9%(16/18)、58.33%(14/24)、68.29%(28/41)、76.47%(13/17),高危HPV阳性率分别为27.78%(5/18)、91.67%(22/24)、97.56%(40/41)、100%(17/17),hTERC阳性率分别为11.1%(2/18)、29.17%(7/24)、87.80%(36/41)、100%(17/17)。随着宫颈病变病理级别的递增,高危HPV的表达及hTERC基因扩增出现递次增高。非CIN组高危HPV感染率低于CIN组,差异有统计学意义(P<0.01),CIN1、CIN2及CIN3三组间比较差异无统计学意义(P>0.05),CIN组与宫颈浸润癌组差异无统计学意义(P>0.05)。hTERC基因扩增率高级别CIN组及浸润癌组明显高于低级别CIN1组(P<0.01)。结论:在宫颈癌筛查中,细胞学检查具有较高的特异性(92.5%),但灵敏度较差(53.4%),高危HPV检测灵敏度高(96.7%),但特异性差(44.6%),hTERC基因扩增筛查高级别CIN病变特异性高(98.6%),灵敏度稍低(71.7%),在宫颈组织的表达率与宫颈病变程度密切相关,三种方法联合检测可以大大提高宫颈癌前病变的阳性检出率,有利于较特异地识别出具有较高的转化为宫颈癌潜能的高级别CIN病变。

Objective： To investigate the significance of unite apply of genomic amplification of the human telom- erase RNA component （hTERC） gene and high risk hmnan papilloma virus detection and fiquid-based cytological test for the screening of cervical cancer. Methods： From May 2010 to Jan. 2012,100 specimens were obtained from patients with cervical problems in our hospital. The specimens were evaluated by the Digene Hybrid Capture 2 （ HC2 ） HPV DNA test and fluorescence in situ hybridization （FISH） with a chromosome probe to TERC and thinprep liquid based cytology test （ TCT ）. At the same time, Histological evaluations were performed, The results of these 3 methods were compared with the results of histological evaluation. Results ： In the normal, cervical intraepithelial neoplasia grade 1 （ CIN1 ）, grade 2 （CIN2）, grade 3 （CIN3） and squamous cervical cancer （SCC） cases, the coincidence rate of TCT and histological evalu- ation were 88.9% （ 16/18）, 58.33% （14/24） ,68.29% （28/41） ,76, 47% （13/17） respectively. The HR-HPV posi- tive rates were 27.78% （5/18） ,91.67% （22/24）, 97.56% （40/41）, 100% （ 17/17 ）respectively. The positive rate of HR-HPV DNA in CIN was higher than that in the normal group（p 〈 0.01 ） and statistics difference was neither found among CIN groups （ P 〉 0. 05 ） nor between CIN and SCC groups（P 〉0.05）. The amplification of hTERC was higher in higher grade cervical diseases and its positive rates were higher in the CIN2 ＋ （CIN2, CIN3 and SCC） group than in the normal and CIN 1 groups （p 〈 0. 01 ）. Conclusion： Liquid-based cytology is the most often used method for cervical cancer screening. It is specific（92.5% ） but relatively insensitive（53.4% ） and frequently gives equivocal results. HR-HPV DNA test is highly sensitive（96.7% ） but not very specific（44.6% ）. The TERC amplification test has higher specificity（98. 6% ）and lower sensitivity（71.7% ） , it can easily identify high grade CIN. hTERC and HPV DNA and TCT co-testing shows an optimal combination of sensitivity and specificity for cervical cancer screening as well as can identify high grade CIN.