薄层液基细胞学检测联合DNA倍体分析在宫颈癌前病变早期筛查中的价值

Value of thinprep cytology test combined with DNA ploidy analysis on the early screening for cervical precancerous lesion

目的探讨薄层液基细胞学检测(TCT)联合DNA倍体分析在宫颈癌前病变早期筛查的应用价值。方法选取2013年5月至2015年4月在新疆生产建设兵团第一师阿拉尔市医院就诊患者1 000例,均进行TCT和DNA倍体分析,对TCT结果阳性或DNA倍体分析阳性的患者进行活体组织病理学检查,以活体组织病理学检查作为最终诊断结果,比较2种方法单独使用与联合使用发现宫颈病变的灵敏度和特异度。结果 1 000例受试者通过TCT和DNA倍体分析,共发现阳性患者210例。TCT发现宫颈病变的灵敏度为69.9%(93/133),特异度为39.0%(30/77),阳性预测值为66.4%(93/140),阴性预测值为42.9%(30/70)。DNA倍体分析发现宫颈病变的灵敏度为68.4%(91/133),特异度为29.9%(23/77),阳性预测值为62.8%(91/145),阴性预测值为35.4%(23/65)。TCT联合DNA倍体分析发现宫颈病变的灵敏度为85.7%(114/133),特异度为74.0%(57/77),阳性预测值为85.1%(114/134),阴性预测值为74.0%(57/77)。TCT与DNA倍体分析发现宫颈病变的灵敏度及特异度比较差异均无统计学意义(P>0.05);TCT联合DNA倍体分析发现宫颈病变的灵敏度和特异度均显著高于单独TCT和单独DNA倍体分析(P<0.01)。结论 TCT联合DNA倍体分析能显著提高宫颈癌前病变检测的灵敏度和特异度,对宫颈癌前病变的早期筛查具有重要意义。

Objective To explore the value of thinprep cytology test（ TCT） combined with DNA ploidy analysis on the early screening for cervical precancerous lesion. Methods A total of 1 000 patients were selected in Alaer Hospital of the First Division of Xinjiang Production and Construction Corps from May 2013 to April 2015. All the patients were performed with TCT and DNA ploidy analysis. The patients with positive result of TCT or DNA ploidy analysis were performed with biopsy. The pathological examination was as the final diagnosis results. The sensitivity and specificity of only TCT,DNA ploidy analysis or combined detection to cervix disease were compared. Results Among the 1 000 patients,210 positive patients were found by TCT and DNA ploidy analysis. The sensitivity,specificity,positive predictive value and negative predictive value of TCT on cervical disease was 69. 9%（ 93 /133）,39. 0%（ 30 /77）,66. 4%（ 93 /140） and 42. 9%（ 30 /70） respectively. The sensitivity,specificity,positive predictive value and negative predictive value of DNA ploidy analysis on cervical disease was68. 4%（ 91 /133）,29. 9%（ 23 /77）,62. 8%（ 91 /145） and 35. 4%（ 23 /65） respectively. The sensitivity,specificity,positive predictive value and negative predictive value of TCT combined with DNA ploidy analysis on cervical disease was 85. 7%（ 114 /133）,74. 0%（ 57 /77）,85. 1%（ 114 /134） and 74. 0%（ 57 /77） respectively. There was no significant difference in the sensitivity and specificity between TCT and DNA ploidy analysis on cervical disease（ P〉0. 05）. The sensitivity and specificity of TCT combined with DNA ploidy analysis on cervical disease were significantly higher than those of TCT or DNA ploidy analysis（ P〈0. 01）. Conclusions TCT combined with DNA ploidy analysis can significantly improve the sensitivity and specificity in the detection of cervical precancerous lesions. It has important significance for the early screening of cervical precancerous lesions.