DNA倍体分析技术在门诊患者子宫颈癌筛查中的作用

目的 探讨DNA倍体分析在门诊患者子宫颈癌筛查中的应用价值.方法 对门诊行子宫颈癌筛查的2 692例女性就诊者同时进行液基薄层细胞学检查、DNA倍体分析,对其中可疑病变者840例进行子宫颈活组织检查.对参与子宫颈癌普查的妇女进行液基薄层制片,分别进行巴氏染色和Feulgen染色,由细胞学医师对巴氏染色片作常规细胞学诊断,应用全自动DNA倍体分析系统对Feulgen染色片进行自动扫描诊断.结果 840例患者子宫颈活组织病理检查结果分别为：慢性子宫颈炎554例（66.0％）,子宫颈上皮内瘤变（CIN）Ⅰ 25例（3.0％）,CINⅡ59例（7.0％）,CINⅢ100例（11.9％）,子宫颈癌102例（12.1％）.DNA倍体分析中可见DNA异倍体细胞者（DNA异倍体细胞阳性）486例,未见DNA异倍体细胞者（DNA异倍体细胞阴性）354例;DNA异倍体细胞阳性、异倍体细胞≥3个用于筛查CINⅡ及以上病变的敏感度、特异度、阳性预测值、阴性预测值分别为91.9％和89.2％、58.5％和35.8％、49.4％和57.3％、94.1％和77.2％;采用液基薄层细胞学检查LSIL及以上用于筛查CINⅡ及以上病变的敏感度、特异度、阳性预测值、阴性预测值分别为40.2％、90.0％、39.6％和76.9％.结论 DNA倍体定量分析技术较常规细胞学敏感性高,可作为子宫颈癌普查的指标之一.

The significance of DNA ploidy analysis in cervical carcinoma screening for outpatients

Objective To investigate the value of DNA ploidy analysis in cervical cancer screening for outpatients.Methods 840 from 2 692 outpatients examed by Thin Prep cytology,DNA ploidy analysis were performed directed biopsy simultaneously.Sample were taken by cervix brush and transported into a fixative solution.Two slides were made from each sample for staining with Feulgen DNA specific staining and the other with Pap stained,respectively.The routine cytological diagnosis of Pap smear was done by cytology physicians,and the Feulgen staining tablets by the automated DNA ploidy analysis system.Results Among 840 cases,554 cases （66.0 %） were histological diagnosed as chronic cervicitis,25 cases （3.0 %） as cervical intraepithelial neoplasia （CIN） Ⅰ,59 cases （7.0 %） as CIN Ⅱ,100 cases （11.9 %） as CINⅢ and 102 cases （12.1%） as cervical invasive cancer by pathological biopsy.486 cases were observed with DNA heteroploid and 354 were not.The sensitivity,specificity,positive predictive values and negative predictive values of scanning CIN Ⅱ or more severe cervical diseases by DNA heteroploid positive or heteroploid ≥3 for were 91.9 % or 89.2 %,58.5 % or 35.8 %,49.4 % or 57.3 %,94.1% or 77.2 %,respectively,while those of scanning equal or more than LSIS andthe above diseases by Thin Prep cytology were 40.2 %,90.0 %,39.6 % and 76.9 %.Conclusion DNA ploidy analysis might be a useful tool for cervical cancer screening and has a competitive sensitivity compared with conventional cytology.