宫颈癌筛查中DNA定量分析与薄层液基细胞学检查对比分析

Comparative analysis of DNA quantitative cytology and TCT in cervical cancer screening

目的 比较DNA定量分析与薄层液基细胞学（TCT）检查在宫颈癌中的应用价值,以提高细胞学诊断的准确性.方法 对7 470例妇女行宫颈薄层液基细胞学（TCT）及DNA定量分析,结果异常者用二代基因杂交捕获法（HC2）检测高危型人乳头状瘤病毒（HPV）,TCT在ASC及以上病变为阳性,DNA指数≥2.5为阳性.结果 7470例患者,用DNA定量分析法检测阳性率为13.0％,TCT检查阳性率为13.7％,两种检查方法差异无统计学意义（x2 =1.813,P=0.178）;≥3个细胞2.5≤DNA指数＜4.5者及DNA指数≥4.5者的TCT阳性率明显高于＜3个细胞2.5≤DNA指数＜4.5者;不同级别TCT异常,均可发现有DNA指数异常细胞,TCT病变级别越高,DNA倍体异常细胞和异倍体细胞峰出现频率越大;不同程度的DNA异常其高危型HPV感染率差异有统计学意义（x2=62.648,P=0.000）.结论 DNA定量分析联合TCT作为宫颈癌筛查方法有可行性,可以减少漏诊和误诊,指导临床进行宫颈活检,对高危型HPV感染起提示作用.

Objective To compare the cytology diagnostic accuracy of DNA quantitative cytology and thinprep cytology test（TCT） in cervical cancer screening for exploring effective method in cervical cancer screening.Methods TCT and DNA quantitative cytology were carried out in 7 470 women.Women with positive results additionally underwent high risk human papillomavirus （HPV） detection.Positive cytologic diagnosis included atypical squamous cells（ASC） or above in TCT and DNA index 2.5 or above in DNA quantitative cytology.Results The positive rate was 13.0% in method of DNA quantitative cytology and 13.7% in method of TCT in 7 470 cases.Positive rate of the two methods had no significant difference in cervical cancer screening（x2 =1.813,P =0.178）.There was significant difference in positive rate of TCT between cases with DNA index≥2.5,〈4.5,heteroploid cells more than 3 or DNA index≥4.5 and cases with DNA index≥2.5,〈4.5,heteroploid cells less than 3.Every grade of TCT abnormality had abnormal DNA index.Abnormality of DNA index had an increasing trend with the severity of TCT.Infection rate of high risk HPVs had significant difference in different grades of DNA index （x2 =62.648,P =0.000）.Conclusion Combination of DNA quantitative cytology and TCT is an effective method in cervical cancer screening,which can reduce misdiagnosis,guide cervical biopsy and suggest infection of high risk of HPVs.