液基细胞学联合DNA倍体分析在宫颈癌筛查中的应用

Use of liquid based cytology and DNA ploidy analysis in screening cervical lesions

目的探讨提高宫颈病变筛查检出率的最有效途径。方法对体检中心参加宫颈癌筛查的12 000名妇女进行宫颈液基细胞学筛查(TCT)及DNA倍体分析。结果 TCT异常者检出率为6.0%(720/12 000)。其中,非典型鳞状上皮细胞(ASC-US)为2.5%(300/12 000),低度鳞状上皮内病变(LSIL)为2.1%(252/12 000),高度鳞状上皮内病变(HSIL)及以上为1.4%(168/12 000)。DNA倍体分析异常为5.9%(713/12 000)。若组织学CINI及以上级别为需要处理癌前病变的标准,液基细胞学方法敏感度为58.0%(237/408),特异度为88.0%(669/756),阳性预测值为73.1%(237/324),阴性预测值为79.6%(669/840);DNA倍体分析方法敏感度为80.1%(327/408),特异度为70.1%(530/756),阳性预测值为59.1%(327/553),阴性预测值为86.7%(530/611);液基细胞学联合DNA倍体分析方法敏感度为81.4%(332/408),特异度为65.7%(497/756),阳性预测值为56.2%(332/591),阴性预测值为86.7%(497/573)。结论液基细胞学联合应用DNA倍体分析,能提高宫颈癌前病变及宫颈癌筛查的检出率。

Objective We ai med to i nvest igate a n ef fect ive approach to improve detection rate for screening the cervical lesions. Methods The TCT analysis,DNA ploidy analysis were used to screen the women coming to our Health Check Centre. Results The detection rate of TCT abnormalities was 6%（720/12 000）,of which detection rate of ASCUS was 2.5%（300/12 000）,LSIL was 2.1%（252/12 000）,HSIL and above were 1.4%（168/12 000）. The abnormal DNA ploidy analysis occurred in 5.94%（713/12 000）. For the TCT analysis,the sensitivity of 58.0%,the peculiarity of 88.0%,the positive predictive value of 73.1%,the negative predictive value of 79.6% were calculated for cases of CINI or above; for DNA ploidy analysis,the sensitivity of 80.1% and specificity of 70.1% and positive predictive value of 59.1% and negative predictive value of 86.7% were calculated for cases of CINI or above; for TCT combined with the DNA ploidy analysis,sensitivity of 81.4%,the peculiarity of 65.7%,the positive predictive value of 56.2%,the negative predictive value of 86.7% were calculated for cases of CINI or above. Conclusion The TCT screening combined with DNA ploidy analysis might improve the detection rate of cervical precancerous lesions and early cervical carcinoma.