细胞DNA定量分析在宫颈病变筛查中的应用价值

Application Value of Quantitative Analysis of Cell DNA in Cervical Lesion Screening

目的探讨细胞DNA定量分析技术在宫颈病变筛查中的应用价值。方法回顾性分析我院82 518例宫颈病变筛查结果,以活检病理结果为金标准,比较细胞DNA定量分析与液基细胞学检查(TCT)诊断宫颈病变的敏感度、特异度、阳性预测值及阴性预测值。应用受试者工作特征曲线评价2种诊断方法的准确性。结果细胞DNA定量分析、TCT及联合诊断筛查宫颈高度鳞状上皮内病变及宫颈癌的敏感度分别为77.37%、70.97%、90.24%,特异度分别为65.59%、70.42%、45.06%。细胞DNA定量分析的敏感度高于TCT,但特异度低于TCT,联合诊断筛查敏感度最高。TCT诊断为不典型鳞状上皮细胞(ASCUS)的患者中,细胞DNA定量分析阳性者42.71%活检病理结果为宫颈高度鳞状上皮内病变或宫颈癌,而阴性者仅为12.5%。细胞DNA定量分析筛查宫颈腺癌的漏诊率(39.13%)高于筛查宫颈鳞状细胞癌的漏诊率(15.11%),薄层细胞学涂片细胞数<5 000个的漏诊率(57.83%)远高于细胞数>5 000个的漏诊率(22.63%),联合TCT可以使筛查的漏诊率从20.19%降至13.38%。结论细胞DNA定量分析是一种有效的宫颈病变筛查手段,对宫颈高度鳞状上皮内病变及宫颈鳞状细胞癌的敏感性高于TCT,且可对ASCUS患者进行有效分流,其筛查效果略优于TCT。但细胞DNA定量分析特异度低于TCT,且对宫颈腺癌的筛查漏诊率高。细胞DNA定量分析与TCT联合应用可显著提高筛查的敏感性。

Objective To determine the application value of quantitative detection of DNA in cervical lesion screening. Meth- ods Retrospective analysis of 82 518 eases of cervical lesions was carried out. The sensitivity,specificity,positive predictive value （PPV）, and negative predictive value （NPV） of DNA quantification and ThinPrep cytology test （TCT） for the diagnosis of cervical lesions were compared with the results of biopsy. The accuracy of the two methods was evaluated by applying the receiver operating characteristic curve. Results The sensitivity of DNA quantification,TCT, and combined diagnosis was 77.37%,70.97%, and 90.24%,respectively, and the specificity was 65.59%, 70.42%, and 45.06%, respectively. The sensitivity of cell DNA quantitative analysis was higher but the specificity was lower than that of TCT, while the sensitivity of combined diagnosis was the highest. In DNA quantitative analysis of patients with and without atypical squamous cells of undetermined significance （ASCUS）, the positive rates of pathology were 42.71% and 12.5%, respectively. The misdiagnosis rate of cell DNA quantitative analysis for screening cervical adenocarcinoma （39.13%） was higher than that for screening cervical squamous cell carcinoma （15.11%）. In a cytologic smear, the misdiagnosis rate of ceils 〈 5 000 （57.83%）was much higher than that of cells 〉 5 000 （22.63%）. However, a combined diagnosis with TCT could reduce the misdiagnosis rate from 20.19% to 13.38%. Conclusion Cell DNA quantification is more sensitive than TCT,but the specificity of cell DNA analysis is lower than that of TCT, and the screening rate for cervical adenocarcinoma is high. Quantitative DNA analysis combined with TCT can significantly improve the screening sensitivity.