DNA倍体分析和液基细胞学在宫颈病变早期筛查中的应用

Application of DNA ploidy analysis and ThinPrep liquid-based cytology test of cervical cells to early screening of cervix lesions

目的探讨DNA倍体分析和液基细胞学在宫颈病变早期筛查中的应用。方法以阴道镜下活检为金标准,分析2014年1-6月在湖北省妇幼保健院妇科同时行DNA倍体分析和液基细胞学检查的297例患者检测结果。结果297例患者中198例DNA阴性:其中宫颈液基细胞学为NILM为187例,ASCUS为9例,LSIL为2例。而阴道镜活检结果为慢性宫颈炎182例,CINⅠ11例,CINⅢ3例,宫颈癌2例;DNA倍体异常99例:其中宫颈液基细胞学为NILM为20例,ASCUS为45例,LSIL为23例,HSIL为11例。而阴道镜活检结果为慢性宫颈炎37例,CINⅠ25例,CINⅡ9例,CINⅢ18例,宫颈癌10例。DNA倍体分析和液基细胞学预测CINⅡ及以上病理改变,其敏感性、阴性预测值分别为88.10%和78.57%、97.47%和95.65%。两种方法联合检测预测CINⅡ及以上病理改变,其敏感性、阴性预测值分别为95.24%、98.93%。结论 DNA倍体分析可用于宫颈病变的早期筛查,联合液基细胞学敏感性高,可降低漏诊率。

Objective To study the application of DNA ploidy analysis and ThinPrep liquid - based cytology to the early screening of cervical lesions. Methods We retrospectively analyzed the results of DNA ploidy analysis and ThinPrep liquidbased cytology test （TCT） in 297 patients from Hubei Provincial Maternal and Child Health Hospital from January to June, 2014, and histological biopsy under colposcope was selected as the gold standard. Results Of the 297 patients, 198 were negative for DNA ploidy. TCT examination results of the 198 patients showed that 187 patients were negative for intraepithelial lesion or malignancy （NILM）, 9 were atypical squamons cells of undetermined significance （ASCUS） and 2 were low- grade squamons intraepithelial lesion （LSIL）. But the results of histological biopsy under colposcope displayed that 182 patients were chronic cervicitis, 11 were cervical intraepithelial neoplasia （CIN） Ⅰ, 3 were CIN Ⅲand 2 were cervical cancer. 99 patients were detected abnormality through DNA ploid analysis. TCT examination results of the 99 patients indicated that 20 patients were NILM, 45 were ASCUS, 23 were LSIL and 11 were highgrade squamons intraepithelial lesion （HSIL）, but the results of histological biopsy under colposcope showed that 37 patients were chronic cervicitis, 25 were CIN Ⅰ, 9 were CIN Ⅱ, 18 were CIN Ⅲ and 10 were cervical cancer. The sensitivity and negative predictive value of DNA ploidy analysis and ThinPrep liquid - based cytology test in the pathological changes （CIN Ⅱ/Ⅲ） were 88.1% and 78.57%, 97.47% and 95.65% respectively. When the above-mentioned two methods were combined to predict the pathological changes （CIN Ⅱ/Ⅲ）, the sensitivity and negative predictive value were 95.24 % and 98.93 % respectively. Conclusions DNA ploidy analysis is suitable for the early screening of cervical lesions. DNA ploidy analysis combined with Thinprep liquid - based cytology test can lower the misdiagnosis rate of cervical lesions owing to its high sensitivity.