ATP10a甲基化对宫颈脱落细胞学为ASCUS患者分层管理的意义

Significance of ATP10a methylation for stratified management of ASCUS patients by cervical exfoliative cytology

目的:探讨ATP10a甲基化检测对宫颈脱落细胞学为ASCUS患者分层管理的意义。方法:选取168例宫颈脱落细胞学结果为ASCUS患者,行ATP10a甲基化及HR-HPV分型检测,阴道镜检查和宫颈活检。以活检组织病理结果为金标准,对比ATP10a甲基化、HR-HPV分型检测在此类人群中诊断HSIL+(HSIL+SCC)的效能。结果:ATP10a甲基化阳性率在HSIL+组(HSIL+SCC)为68.18%,显著高于LSIL-组(炎症+LSIL)的26.47%(P<0.05);HR-HPV分型阳性率在HSIL+组(HSIL+SCC)、LSIL-组(炎症+LSIL)分别为92.42%、82.35%,二者比较差异无统计学意义(P>0.05)。在细胞学初筛为ASCUS患者中,ATP10a甲基化诊断HSIL+的曲线下面积(AUC)显著高于HR-HPV分型(0.709,0.550)(P<0.05),其特异性(73.53%)、PPV(62.50%)均高于HR-HPV分型(17.65%、42.07%),差异均有统计学意义(P<0.05);敏感性低于HR-HPV分型(68.18%,92.42%),差异有统计学意义(P<0.05);二者具有相似的NPV(78.13%,78.26%)(P>0.05),且均不会漏诊SCC,但ATP10a甲基化可使阴道镜转诊率下降43.45%。在此类人群中,ATP10a甲基化检测诊断HSIL+的敏感性高于阴道镜镜下诊断,差异有统计学意义(68.18%、63.64%,P<0.05),但二者具有相似的特异性、PPV、NPV、AUC(P>0.05)。结论:ATP10a甲基化检测在宫颈脱落细胞学ASCUS患者中诊断HSIL+的效能优于HR-HPV分型检测且可以在不漏诊宫颈癌的情况下,减少阴道镜转诊率,有望成为分流ASCUS的有效手段之一。

Objective:To investigate the significance of ATP10a methylation detection in stratified management of ASCUS patients.Methods:A total of 168 patients with atypical squamous cell were selected for ATP10a methylation and HR-HPV typing detection,colposcopy and cervical biopsy.The efficacy of ATP10a methylation and HR-HPV typing in the diagnosis of HSIL+(HSIL+SCC)in this population was compared with the pathological results of biopsy histopathology as the gold standard.Results:The positive rate of ATP10a methylation was 68.18%in the HSIL+group(HSIL+SCC),which was significantly higher than that of 26.47%(P<0.05)in the LSIL-group(inflammation and LSIL),and the positive rate of HR-HPV classification was 92.42%and 82.35%in the HSIL+group(HSIL and SCC)and LSIL-group(inflammation and LSIL),respectively,and there was no significant difference between the two groups(P>0.05).In patients with ASCUS,the AUC of ATP10a methylation for the diagnosis of HSIL+was significantly higher than that of HR-HPV typing(0.709,0.550)(P<0.05),and it's specificity(73.53%)and PPV(62.50%)were higher than that of HR-HPV typing(17.65%,42.07%),and the differences were statistically significant(P<0.05),while the sensitivity was lower than that of HR-HPV typing(68.18%,92.42%),the difference was statistically significant(P<0.05).The two groups had similar NPV(78.13%,78.26%)(P>0.05),and neither missed SCC,but ATP10a methylation could reduce the colposcopy referral rate by 43.45%.In this population,ATP10a methylation detection had a higher sensitivity than colposcopic diagnosis of HSIL+and the difference was statistically significant(68.18%,63.64%,P<0.05).The two groups shared similar specificity,PPV,NPV and AUC(P>0.05).Conclusion:ATP10a methylation detection is better than HR-HPV typing detection in the diagnosis of HSIL+in patients with cytology ASCUS,and can reduce the colposcopy referral rate without missing cervical cancer,which is expected to become one of the effective means of shunting ASCUS.