细胞DNA定量分析技术在宫颈癌筛查中的应用价值

Value of cell DNA quantitative cytology in cervical cancer screening

目的通过与液基细胞学诊断比较,探讨细胞DNA定量分析系统在宫颈癌及癌前病变筛查中的应用价值。方法对20418名宫颈癌普查女性做液基薄层细胞涂片2张,分别行液基细胞学检查和Feulgen DNA染色,并用全自动DNA定量分析系统做DNA倍体分析,两者均为阳性的女性在阴道镜下行宫颈组织学活检。以病理诊断结果为标准,计算液基细胞学诊断和细胞DNA定量分析方法对筛查宫颈上皮内瘤变Ⅱ级(CINⅡ)及以上宫颈病变的敏感度、特异度、阳性预测值、阴性预测值。结果液基细胞学检查为低级别鳞状上皮内病变(LSIL)及以上级别评估宫颈上皮内瘤变Ⅱ级(CINⅡ)及以上宫颈病变,其敏感度、特异度分别为61.3%、93.4%;DNA定量分析中以≥3个DNA异倍体细胞作为评估CINⅡ及以上病理改变,其敏感度、特异度分别为81.4%、82.6%。DNA定量分析方法的敏感度明显高于液基细胞学方法。在235例ASC-US患者中,宫颈活检为CINⅡ及以上病变在DNA倍体异常者中占39.9%,而DNA倍体正常者中仅为1.2%。结论细胞DNA分析技术能够较好地提高宫颈癌普查的阳性检出率。在ASC-US分流方面,DNA定量分析有很好的临床指导价值。

Objective To investigate the value of DNA image cytometry in cervical cancer screening by comparing with the conventional cytological results. Methods A total of 20418 cases were included in this study. Two liquid-based smears were made from each patient,one stained with Pap stain and another with Feulgen stain for DNA image cytometry screen. The women with abnormal results in the study underwent cervical biopsy under colposcope and pathological examination. Results The sensitivity,specificity of DNA quantitative analysis（ DNA ploid ≥ 3） and liquid-based monolayer cytology（ LSIL or sever lesions） in screening CINⅡ or severer lesions were 81. 44% and 82. 57%,61. 34%and 93. 37%,respectively. The sensitivity of DNA quantitative analysis was higher than liquid-based monolayer cytology.Among 235 ASC-US,39. 87% of ASC-US with aneuploid cells were comfirmed as CINⅡ or severer lesions,while 1. 22%of ASC-US with diploid cells were diagnosed as CIN Ⅱ or severer lesions. Conclusion DNA image cytometry can be used to stratify those cases of ASC-US. This computer-assisted automated method can be used in cervical cancer screening combined with conventional cytology.