细胞DNA倍体图像分析在宫颈癌及癌前病变筛查中的应用

Value of DNA ploidy analysis in screening of cervical cancer and precancerous lesions

目的利用显微图像分析技术对宫颈脱落细胞做DNA倍体检测、分析，以探讨该技术在宫颈癌及癌前病变筛查中的应用价值。方法对619例宫颈脱落细胞样本分别采用常规细胞学镜检和细胞DNA倍体分析法作检测，其中阳性样本患者行组织活检，并将3种检测结果进行对比分析。结果619例样本，常规细胞学镜检共检出ASC—US42例、ASC—H6例、LSIL29例、HSILl8例；采用细胞倍体分析法检出DI≥2．5时，可见DNA倍体异常细胞（1～2个）的样本102例、DNA倍体异常细胞（≥3个）的样本41例、DNA倍体异常细胞（≥25个）的样本14例；48例组织活检样本检出炎症7例、CINI20例，CINⅡ13例、CINⅢ2例、IC6例。CINⅡ～Ⅲ对应TBS系统中的HSIL计算灵敏度为81．0％；对应SIL和对应ASC＋SIL的灵敏度分别为85．7％和100％。HSIL与CINⅡ～Ⅲ比较有非常显著的统计学意义。CINⅡ～Ⅲ对应DNA倍体异常细胞（≥25个）计算灵敏度为66．7％；对应可见DNA倍体异常细胞（≥3个）的灵敏度为100％。DNA倍体异常细胞（≥25个）与CINⅡ～Ⅲ比较也有非常显著的统计学意义。结论细胞DNA倍体图像分析法在宫颈癌及癌前病变筛查中有较高的灵敏度，若联合常规宫颈细胞学检查，可明显提高宫颈癌筛查的质量控制水平。

Objective To investigate the value of DNA ploidy analysis in screening of cervical precancerous lesions by cytological detection by automatic DNA image cytometry. Methods 619 cases of gynecological samples were involved in this study. The samples had been assessed cancer and A total of by liquidbased cytology and DNA ploidy agnosis. The pathological resul analysis. Then the positive subjects were called back for histopathology dits were used as standard to compare the sensitivity and specificity of these two methods. Results Liquid-based cytology assessment of the 619 cases detected 42 cases of ASC-US, 6 of ASC-H, 29 of LSIL and 18 of HSIL. DNA image cytometry assessed 102 cases of DNA aneuploidy （1 -2 cells） , 41 of DNA aneuploidy （ ≥3 cells） , 14 of DNA aneuploidy （ ≥25 cells） , when DNA index （DI） ≥2.5, 48 cases of positive normal, 20 CIN Ⅰ , 13 CIN Ⅱ, 2CINⅢ detection of CIN Ⅱ-Ⅲ was 81.0% . with subjects were called back, and the pathological results were 7 and 6 IC. The sensitivity of TBS associated with HSIL for the SIL and ASC ＋ SIL were 85.7% and 100% , respectively. HSIL and CIN Ⅱ -Ⅲ were highly significant comparison. The sensitivity of DNA ploidy analysis associated with DNA aneuploidy （ ≥ 25 cells） and DNA aneuploidy （ ≥ 3 cells） for the detection of CIN Ⅱ -Ⅲ was 66.7% and 100%, respectively. DNA aneuploidy （≥25 cells） statistical significance with CIN Ⅱ -Ⅲ were very significant, too. Conclusions DNA ploidy analysis can be used to select samples with high risk of cervical cancer and precancerous lesions. DNA ploidy analysis in combination with liquid-based cytology can improve the quality control of cytological screening of cervical cancer and precancerous lesions.