HPV E6/E7 mRNA联合P16/ki67免疫细胞化学双染色检测在不典型鳞状细胞(ASCUS)分流诊断中的作用

The role of HPV E6/E7 mRNA combined with P16/ki67 immunocytochemistry in the diagnosis of atypical squamous cells of undetermined significance(ASCUS)

目的探讨人乳头瘤病毒(HPV) E6/E7 mRNA联合P16/KI-67抗原(ki67)免疫细胞化学双染色检测对意义不明确的不典型鳞状细胞(ASCUS)分流诊断的价值。方法选取272例患者,回顾性分析剩余的细胞学标本中HPV E6/E7 mRNA及P16/ki67免疫细胞化学双染色检测结果。HPV E6/E7 mRNA检测采用HPV E6/E7 mRNA检测试剂盒利用Panther分子诊断仪进行检测、P16/ki67采用免疫细胞化学染色利用Ventana Benchmark Ultra免疫组织化学染色仪进行。分析两种检测法在同级别宫颈上皮病变中阳性率的差异,探讨两种检测法及二者联合检测在诊断高级别鳞状上皮内病变(HSIL)的效能的差异,综合评估不同检测方法分流诊断ASCUS中的作用。结果宫颈细胞学ASCUS对应的组织病理学结果包括慢性宫颈炎、低级别鳞状上皮内病变(LSIL)、HSIL到宫颈癌等。单纯分子诊断或免疫细胞化学染色检测阳性率随宫颈病变严重程度的加重而增加。在宫颈炎和LSIL病变组中,两种检测法阳性率之间的差异明显,在HSIL和宫颈癌病变组中,两种检测法阳性率之间无显著差异。联合检测法诊断HSIL以上病变的综合性能最佳,其灵敏度、特异度、约登指数、符合率、阳性预测值、阴性预测值分别为95. 65%、85. 40%、0. 81、87. 13%、57. 14%、98. 97%。结论 HPV E6/E7 mRNA和P16/ki67免疫细胞化学染色检测均在ASCUS分流诊断中有一定的意义,联合检测HPV E6/E7 mRNA和P16/ki67明显提高分流诊断的灵敏度,保持了较好的特异度。

Objective To investigate the diagnostic value of human papillomavirus( HPV) E6/E7 mRNA combined with P16/antigen KI-67( ki67) immunocytochemical double staining in the atypical squamous cells of undetermined significance( ASCUS). Methods A total of 272 patients were selected and the results of HPV E6/E7 and P16/ki67 immunocytochemicaldouble staining in the remaining cytological specimens were retrospectively analyzed. HPV E6/E7 gene was detected by HPVE6/E7 gene detection kit and Panther molecular diagnostic instrument. P16/ki67 was detected by immunocytochemicalstaining and Ventana Benchmark Ultra immunohistochemical staining instrument. Then we analyzed the difference of positiverate between the two detection methods in the same grade of cervical epithelial lesions,explored the difference of the twodetection methods and their combined detection in the diagnosis of high grade squamous intraepithelial lesions( HSIL),andfinally evaluated the role of different detection methods in shunt diagnosis of ASCUS. Results Histopathological findings ofcervical cytology ASCUS includes chronic cervicitis,low-grade squamous intraepithelial lesions( LSIL),HSIL and cervicalcancer. The positive rate of simple molecular diagnosis or immunocytochemical staining increased with the severity of cervicallesions. In cervicitis and LSIL lesion group,the difference between the positive rates of the two methods was obvious,but inHSIL and cervical cancer lesion group,there was no significant difference between the positive rates of the two methods. Thesensitivity,specificity,Yoden index,coincidence rate,positive predictive value and negative predictive value were 95. 65%,85. 40%,0. 81,87. 13%,57. 14% and 98. 97%,respectively. Conclusion The detection of HPV E6/E7 and P16/ki67 immunocytochemical staining has certain significance in ASCUS shunt diagnosis. The combined detection of HPV E6/E7 andP16/ki67 can significantly improve the sensitivity of shunt diagnosis and maintain a good specificity.