DNA定量分析技术作为食管癌及癌前病变初筛方法的探索性研究

[目的]探索DNA定量分析方法作为食管癌癌前病变的初筛方法的可行性。[方法]选取食管癌高发区林州市40～69岁内镜筛查确诊的食管癌及其各级癌前病变患者79例,通过脱落细胞学检查获得食管上皮细胞标本,双盲进行液基细胞学和DNA定量分析诊断。基于病理诊断结果,比较DNA定量分析与液基细胞学的筛查能力。[结果]基于中度不典型增生及以上,DNA定量分析中至少2个异倍体细胞数的灵敏度86.0%,特异度65.5%,优于细胞学≥ASCUS灵敏度为82.0%,特异度为65.5%;DNA定量分析≥4个异倍体细胞数或≥ASCUS的灵敏度和特异度分别为90.0%和62.1%。[结论]DNA定量分析方法初筛食管癌及其癌前病变的灵敏度与特异度略优于液基细胞学,在诊断效率、重现性、预后预测等方面颇具优势。作为初筛方法具有可行性,但尚需大样本量人群筛查验证。

DNA Image Cytometry Technique as a Primary Screening Method for Esophageal Squamous Carcinoma and Precancerous Lesions

[Purpose] To explore the feasibility of DNA image cytometry as a primary screening method for esophageal squamous precancerous lesions.[Methods] Seventy-nine local residents aged 40～69 years old with esophageal cancer or precancerous lesions pathologically proven were recruited in high-risk area,Linzhou,Henan province. Esophageal epithelial cells were obtained by inflatable balloon,then the sample were diagnosed by liquid-based cytology or DNA image cytometry with double blinded. Based on pathological results,sensitivity and specificity of DNA image cytometry were compared with those of liquid-based cytology. [Results] Based on moderate dysplasia or worse,the sensitivity and specificity of DNA image cytometry with at least 2 aneuploid cells were 86.0% and 65.5%,respectively,which were better than those of liquid-based cytology with ASCUS or worse,82.0% and 65.5%,respectively. Sensitivity and specificity of the combination of DNA image cytometry and liquid-based cytology（at least 4 aneuploid cells or ≥ASCUS） were 90.0% and 62.1%,respectively. [Conclusion] The sensitivity of DNA image cytometry is slightly better than that of liquid-based cytology as a screening method for esophageal precancerous lesions,but the former has advantages in diagnosis efficiency,reproducibility,and prognosis. It is possible to use DNA image cytometry as a primary screening method for esophageal precancerous lesions,however,large numbers of sample are needed to verify this conclusion.