液基细胞学联合P16INK4a和cyclin E用于诊断宫颈上皮内瘤变的意义

目的:探讨液基细胞学(liquid-based cytology test,LCT)联合p16INK4A和cyclin E用于诊断宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的价值。方法:225例宫颈病变患者,其中宫颈鳞状细胞癌(squamous cell carcinomas,SCC)56例,高度鳞状上皮内病变(high grade squamous intraepithelial lesions,HSIL)41例,低度鳞状上皮内病变(low grade squamous intraepithelial lesions,LSIL)76例,不典型鳞状细胞(atypical squamous cell lesions,ASC)32例,正常范围(within normal limits,WNL)20例。采用免疫组化法检测p16INK4A和cyclin E的表达。比较单纯LCT及LCT联合p16INK4A和cyclin E的病理诊断符合率。结果:单纯LCT病理诊断符合率为LSIL 52.08%,HSIL 77.14%,SCC 98.21%;LCT联合p16INK4A和cyclin E的病理诊断符合率为LSIL 87.50%,HSIL97.14%,SCC 100%,差异有统计学意义(P(0.05)。32例ASC的LCT联合p16INK4A和cyclin E的阳性病理诊断符合率为85.71%,与单纯LCT的差异有统计学意义(P(0.05)。结论:LCT联合P16INK4a和cyclin E可用于筛查CIN,尤其对ASC的确诊,较单纯LCT有更高的病理诊断符合率,可以提高CIN的诊断准确性。

The significance of liquid-based cytology test in combination with p16INK4a and cyclin E in diagnosis of cervical intraepithelial neoplasia.

Objective:To investigate the value of liquid-based cytology test(LCT) in combination with p16INK4a and cyclin E in the diagnosis of cervical intraepithelial neoplasia(CIN).Methods:225 patients were investigated in the present study,including 56 squamous cell carcinomas(SCC),41 high grade squamous intraepithelial lesions(HSIL),76 low grade squamous intraepithelial lesions(LSIL),32 atypical squamous cell lesions(ASC) and 20 cases within normal limits(WNL).LCT was used in all the patients.Immunohistochemistry was performed to examine the expressions of p16INK4a and cyclin E.The pathological results were used as the gold standard to evaluate the results of LCT method and the combination of LCT with p16INK4a and cyclin E.Results:Compared with the pathological results,the accuracies of LCT method were 52.08%,77.14% and 98.21% in LSIL,HSIL,SCC,respectively.The accuracies of LCT in combination with p16INK4a and cyclin E were 87.50%,97.14% and 100% in LSIL,HSIL and SCC,respectively.The difference was significant(P﹤0.05).In 32 cases of ASC,the accuracy of LCT in combination with p16INK4a and cyclin E was 85.71%,compared with LCT method only and the difference was significant(P﹤0.05).Conclusion:LCT in combination with p16INK4a and cyclin E may be a useful method in screening of CIN,especially in the diagnosis of ASC.