人工智能技术辅助测量宫颈黏膜鳞状上皮厚度及其与宫颈癌前病变的相关性分析

Artificial intelligence aided measurement of cervical squamous epithelial thickness and its correlation with cervical precancerous lesions

目的探讨宫颈黏膜鳞状上皮厚度及其与宫颈癌前病变的相关性。方法筛选解放军总医院第一医学中心及第七医学中心病理科2020年1至6月宫颈活检组织209例,HE切片总计495张,其中含低级别鳞状上皮内病变(LSIL)的切片数为173张,含高级别鳞状上皮内病变(HSIL)的切片数为214张。应用人工智能标注软件,辅助测量每张切片上正常宫颈鳞状上皮、LSIL及HSIL的上皮厚度,每张切片分别选取最厚处、最薄处及中间宽度,3个数值之和除以3即为平均鳞状上皮厚度。然后结合年龄及病理学诊断等资料,进行相关统计学分析。结果 (1)正常宫颈黏膜鳞状上皮平均厚度(245.83±91.40) μm,LSIL上皮平均厚度(222.42±81.22) μm,HSIL上皮平均厚度(195.95±66.59) μm,差异具有统计学意义(P<0.05);(2)正常宫颈黏膜鳞状上皮平均层数为(15.5±4.2)层,LSIL病变平均层数为(14.8±4.8)层,HSIL病变上皮平均层数为(15.8±4.8)层。三组之间差异无统计学意义(P>0.05);(3)按照≤30岁,31~40岁,41~50岁,51~60岁及>60岁对年龄进行分层分析,结果显示:正常宫颈黏膜鳞状上皮厚度随着年龄增加逐渐变薄(相关系数r=-0.141 9,P<0.05),而LSIL和HSIL病变上皮厚度和年龄无显著相关性(P>0.05)。在≤50岁年龄分组内,正常宫颈黏膜鳞状上皮最厚,其次为LSIL,而HSIL上皮厚度最薄,且三者之间差异有统计学意义(P<0.05)。而在>50岁年龄分组内,三者鳞状上皮厚度差异无统计学意义(P>0.05)。结论≤50岁患者的宫颈黏膜鳞状上皮厚度随着癌前病变程度增高逐渐变薄,但50岁以后,随着绝经期到来,正常黏膜上皮萎缩,因此黏膜厚度与病变程度不再具有相关性。另外,也提示阴道镜检查时宫颈醋白试验或碘试验表现与黏膜上皮细胞内蛋白变化相关,而非与上皮层次厚度直接相关。

Objective To study the thickness of cervical squamous epithelia and its correlation with cervical precancerous lesions.Methods We selected 495 HE slides of 209 cervical biopsies from January 2020 to June 2020 in the Department of Pathology,the First and Seventh Medical Center of the PLA General Hospital,including 173 slides with low grade squamous intraepithelial lesion(LSIL)and 214 slides with high grade squamous intraepithelial lesion(HSIL).Artificial intelligence labeling software was used to assist in measuring the epithelial thickness of normal cervical squamous epithelium,LSIL and HSIL of each slide.The thickest,thinnest,and middle widths of epithelial thickness were measured,respectively.Average epithelial thickness was defined as the sum of the above three widths divided by 3.The correlation statistical analysis was performed by combining the data of age and pathological diagnosis.Results The average thickness of normal cervical squamous mucosa was(245.83±91.40)μm,which was(222.42±81.22)μm and was(195.95±66.59)μm in LSIL and HISL epithelial respectively(F=27.09,P<0.01).The average cell layers of normal cervical squamous epithelium was(15.5±4.2)layers,which of LSIL was(14.8±4.8)layers,and that of HSIL was(15.8±4.8)layers.The differences among normal,LSIL and HSIL were not statistically significant(P>0.05).Further statistical analysis was stratified by age(≤30 years,31-40 years,41-50 years,51-60 years,and>60 years),the results of Pearson correlation analysis showed that the thickness of normal cervical squamous epithelial gradually thinned with age(correlation coefficient r=-0.1419,P<0.05),while LSIL and HSIL epithelial thickness had significant correlation with age(P>0.05).In the subgroup of≤50 years old,the epithelial thickness of normal squamous epithelium was the thickest,followed by LSIL,and HSIL epithelial thickness was the thinnest.The differences were statistically significant(P<0.05).While in the subgroup of>50 years,the differences were not statistically significant(P>0.05).Conclusions The cervical squamous epithelium gradually becomes thinner with the degree of precancerous lesions increasing among patients of≤50 years old.However,after age of 50 years,with the onset of menopause,the normal mucosal epithelium is becoming atrophy,so that mucosal thickness is no longer correlated with the extent of the lesion.In addition,it is suggested that the cervical vinegar white test performance during colposcopy is related to the protein changes in the mucosal epithelial cells,but not directly related to the thickness of the epithelial layer.