DNA定量分析在宫颈早期病变诊断中的应用及其对细胞学ASCUS的临床意义

目的:研究DNA定量分析在宫颈早期病变诊断中对不能明确意义的不典型鳞状细胞（ASCUS）的诊断价值。方法:选择2015-2016年宫颈筛查1980例妇科宫颈普查病例，均行薄层液基细胞学检查（TCT）和DNA定量分析，241例在阴道镜引导下行宫颈活检，以组织学诊断为金标准，评估DNA定量分析的诊断价值及其对ASCUS的临床意义。结果:241例病人中DNA倍体正常组（128例）、1~2个异倍体细胞组（54例）及 ≥ 3个异倍体细胞组（59例），3组活检分别诊断CIN Ⅱ及以上病变7例、7例、30例，细胞DNA倍体分析与组织病理学结果显示，病变级别与DNA倍体异常数呈正相关（r_s=0.439，P<0.01），其敏感性为84.1%，特异性为61.4%。活检的57例ASCUS病人中伴1~2个DNA异倍体细胞8例，伴 ≥ 3个异倍体细胞28例，伴DNA倍体正常21例，3组分别诊断CIN Ⅱ及以上病变1例、13例、1例，ASCUS病例伴DNA倍体异常的组织病理学级别与DNA倍体异常数呈正相关（r_s=0.424，P<0.01）。结论:DNA定量分析可提高宫颈早期病变的检出率，而ASCUS伴有 ≥ 3个异倍体细胞时CIN Ⅱ及以上病变的风险最高，二者结合可提高筛查质量、指导临床处置。

Diagnostic value of DNA quantitative analysis in early screening of cervical lesion,and its clinical significance in cytology of ASCUS

Objective:To assess the diagnostic value of DNA quantitative analysis in early screening of cervical lesions,and investigate its clinical significance in cytology of atypical squamous cells of undetermined significance(ASCUS).Methods:The thinprep cytology test(TCT) and cell DNA quantitative analysis were implemented in 1 980 cervical census from January 2015 and December 2016.The biopsies under colposcopy in 241 cases were detected.Under the histological diagnosis being set as the gold standard,the diagnostic value of DNA quantitative analysis and its clinical significance in cytology of ASCUS were evaluated.Results:Among 241 cases,7 cases in normal DNA ploidy group(128 cases),7 cases in heteroploid cell group(54 cases) and 30 cases in equal to or more than 3 heteroploid cell group(59 cases) were diagnosed for cervical intraepithelial neoplasia grade 2(CIN Ⅱ),respectively.The results of DNA ploidy analysis and histopathology showed that the lesion grade was positively correlated with the abnormal DNA ploidy number(r_s=0.439,P<0.01),the sensibility and specificity of which were 84.1% and 61.4%,respectively.Among 57 cases with ASCUS,1 to 2 abnormal DNA ploidy cells in 8 cases, ≥ 3 abnormal DNA ploidy cells in 28 cases and normal DNA ploidy cell in 21 cases were identified.The cases of grade CIN Ⅱ and above in three groups were 1 case,13 cases and 1 case,respectively.The histopathology grade in ASCUS patients complicated with abnormal DNA ploidy was positively correlated with the abnormal DNA ploidy(r_s=0.424,P<0.01).Conclusions:DNA quantitative detection can improve the early screening rate of the cervical lesions,the risk of CIN Ⅱ or above in ASCUS patients complicated with heteroploid cell is the highest.The combination of DNA quantitative analysis and cytology can improve the screening quality to guide the clinical treatment.