细胞DNA定量分析联合液基细胞学在宫颈癌筛查中的临床应用研究

Clinical Application of DNA Quantitative Analysis Combined with Liquid Based Cytology in Cervical Cancer Screening

目的:研究细胞DNA定量分析联合液基细胞学在宫颈癌筛查中的临床应用。方法:从2013年10月至2014年10月,选取实施宫颈癌筛查并且有活检结果的病例1496例。所有病例均是使用宫颈刷进行取材,行液基方式制片两张,一张实施巴氏染色,用来进行常规的细胞学TBS诊断。另外一张进行Feulgen染色处理,用来进行细胞DNA定量分析诊断。结果:本文一共筛查检测1496例适龄的妇女,活检结果显示癌5例,CIN1共40例,CIN2共6例,CIN3共5例。其中6例的CIN2病例中,实施细胞DNA定量分析检测后结果显示为阳性。有5例CINl实施细胞DNA定量分析后结果显示为可疑,进而使得活检被延迟。仅仅使用常规的细胞学进行诊断,有4例CIN2病例被诊断是ASCUS,或会由于被建议进行复查进而导致活检被延迟,使得病情被贻误,特别是有2例宫颈癌也被诊断有ASCUS。有12例CINl被诊断表现为阴性,30例CINl诊断表现为ASCUS。在对较高级别的宫颈癌前的相关病变进行检测时,细胞DNA定量分析方式的敏感性明显大于常规的细胞学检测。一旦使用联合方式诊断,其敏感性明显得到提升。然而和常规的细胞学进行对比,细胞DNA定量分析检测方式的特异性较低。在联合使用情况下,特异性和常规的细胞学进行对比,尽管特异性降低,但是敏感性进一步得到提升。结论:DNA定量细胞学和常规的液基细胞学进行对比,能有效提高阳性细胞的检出率和高级别病变检出的敏感性。两者联合使用,敏感性进一步得到提升,能够有效提升细胞学检测的质量,对宫颈癌筛查起到较为积极的作用。

Objective： To study the clinical application of DNA quantitative analysis combined with liquid based cytology in cervical cancer screening. Method： From October 2013 to October 2014,1496 cases of cervical cancer screening and biopsy results were selected in our hospital. In all cases,two pieces were prepared by using the cervical brush,and the liquid based method was used to carry out the PAP staining,which was used for routine TBS diagnosis. In addition,a Feulgen staining was used for quantitative analysis of DNA cells. Result： A total of 1496 cases of DNA were detected,Biopsy results showed 5 cases of carcinoma,40 cases of CIN1,6 cases of CIN2,5 cases of CIN3. Among them 6 cases of CIN2,and 6 cases of CIN2 were detected. The results showed that the cells were positive after quantitative analysis. The results of5 cases of CINl implementation after the DNA quantitative analysis showed suspicious,and then the biopsy was delayed. Using only conventional cytologic diagnosis,4 cases of CIN2 were diagnosed as ascus,biopsy was delayed perhaps for being recommended for reviewing and then condition was delayed,especially two cases of cervical cancer were diagnosed with ASCUS. 12 cases of CINl were diagnosed as negative,30 cases of CINl were disignosed as ASCUS. The sensitivity of DNA quantitative analysis method was significantly higher than that of conventional cytology in the detection of high grade cervical precancerous lesions. Once used in combination,the sensitivity was significantly improved. However,compared with the conventional cytology,the specificity of DNA quantitative analysis method was lower than that of conventional cytology. In the combined use of cases,specificity and conventional cytology were compared,although the specificity decreased,the sensitivity was further improved. Conclusion： DNA quantitative cytology and conventional liquid based cytology can effectively improve the detection rate of positive cells and the sensitivity of the detection of high- grade lesions. In combination of the two methods,the sensitivity was further improved,which can effectively improve the quality of cytology test and plays a more positive role in cervical cancer screening.