宫颈细胞DNA倍体异常伴ASCUS病变的临床病理学意义

Clinicopathological significance of ASCUS with abnormal DNA ploidy

目的结合DNA倍体分析和The Bethesda system(TBS)诊断结果,研究意义未明的不典型鳞状细胞(atypical squamous cells of undermined significance,ASCUS)伴有DNA倍体异常病例的预后及病理改变。方法南京市妇幼保健院33188名妇女行宫颈癌筛查。用宫颈刷取宫颈上皮细胞,经固定后,离心机制成两张玻片,一张行巴氏染色作TBS诊断;另一张Feulgen染色行DNA倍体分析,其中539例妇女均进行阴道镜检查和组织病理学检查。结果 539例活检病例中,诊断为宫颈炎296例,宫颈上皮内瘤变(cervical intraepithelial neoplasia)1级(CIN1)132例,CIN2 64例,CIN3 38例和浸润癌9例。CIN2或CIN2以上级别病变111例,其中96例有DNA倍体异常(86.5%)。251例常规细胞学诊断为ASCUS,其中无非整倍体细胞168例中发现8例CIN2(4.7%)的病变;而伴有非整倍体细胞的83例中发现17例CIN2或CIN2以上级别的病变(20.5%),两组百分比之间用配对c2检验,有显著差异。活检病例中常规细胞诊断30例非典型鳞状细胞不除外高级别鳞状上皮内病变(atypical squamous cells,cannot exclude high-grade squamous intraepithelial lesion,ASC-H),9例无非整倍体细胞病例中有2例病理诊断为CIN2(22%);21例伴有非整倍体细胞有19例病理诊断为CIN2或CIN2以上级别的改变(90.4%)。两组百分比之间用配对c2检验有统计学上差异。结论 ASCUS、ASC-H伴有DNA倍体异常患者发展为CIN2及以上级别病变风险较高。

Objective Based on DNA ploidy analysis and The Bethesda System(TBS)results,the prognosis and pathological changes of atypical squamous cells of undermined significance(ASCUS)cases w ith D N A ploidy abnormality were studied.Methods 33188 women were screened fo r cervical cancer in Nanjing maternal and child health care hospital.Cervical brush was used to collect epithelial cells which were subsequently fixed and made into two slides:one was subject to Papanicolaou stain for TBS diagnosis,and the other was Feulgen stained fo r DNA ploidy analysis,539 cases had additional colposcopy and histopathological examination.Resuits Among 539 cases w ith cervical biopsy followed by histopathological examination,296 were diagnosed as cervicitis,132 cases of cervical intraepithelial neoplasia 1(CIN1),64 cases of CIN2,38 cases of CIN3 and 9 cases of cervical carcinoma.There were 96 cases(86.5%)of DNA aneuploidy in 111 cases of CIN2 or more advanced stages.From the same pool of patients,251 cases were diagnosed as ASCUS by conventional cytology,8 out of 168 ASCUS cases w ith diploid cells had CIN2(4.7%),w hile 17 out of 83 ASCUS cases w ith aneuploid cells were CIN2 and above(20.5%).of 9 ASC-H cases w ith diploid cells,2 cases(22%)were diagnosed as CIN2,w hile 90.4%were confirmed as CIN2 or worse in 21 ASC-H cases w ith aneuploid cells.There were statistically significant differences between two ASCUS groups and two ASC-H groups by paired Chi-square test.Conclusion ASCUS and ASC-H cases w ith aneuploid cells had higher risk of developing CIN2 or worse lesions.