中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2017, Vol. 46 ›› Issue (11): 1013-1018.doi: 10.12007/j.issn.0258‐4646.2017.11.012

• 论著 • 上一篇    下一篇

细胞DNA定量分析在宫颈病变筛查中的应用价值

张喆,孔令婷,孙寒雪,李晓晗,吕庆杰   

  1. 中国医科大学附属盛京医院病理科,沈阳 110004
  • 收稿日期:2017-04-20 出版日期:2017-11-30 发布日期:2017-11-01
  • 通讯作者: 吕庆杰 E-mail:lvqjie@163.com
  • 作者简介:张喆(1992-),女,硕士研究生

Application Value of Quantitative Analysis of Cell DNA in Cervical Lesion Screening

ZHANG Zhe,KONG Lingting,SUN Hanxue,LI Xiaohan,L Qingjie   

  1. Department of Pathology,Shengjing Hospital,China Medical University,Shenyang 110004,China
  • Received:2017-04-20 Online:2017-11-30 Published:2017-11-01

摘要: 目的 探讨细胞DNA定量分析技术在宫颈病变筛查中的应用价值。方法 回顾性分析我院82 518例宫颈病变筛查结果,以活检病理结果为金标准,比较细胞DNA定量分析与液基细胞学检查(TCT)诊断宫颈病变的敏感度、特异度、阳性预测值及阴 性预测值。应用受试者工作特征曲线评价2种诊断方法的准确性。结果 细胞DNA定量分析、TCT及联合诊断筛查宫颈高度鳞状 上皮内病变及宫颈癌的敏感度分别为77.37%、70.97%、90.24%,特异度分别为65.59%、70.42%、45.06%。细胞DNA定量分析的敏 感度高于TCT,但特异度低于TCT,联合诊断筛查敏感度最高。TCT诊断为不典型鳞状上皮细胞(ASCUS)的患者中,细胞DNA定 量分析阳性者42.71%活检病理结果为宫颈高度鳞状上皮内病变或宫颈癌,而阴性者仅为12.5%。细胞DNA定量分析筛查宫颈腺 癌的漏诊率(39.13%)高于筛查宫颈鳞状细胞癌的漏诊率(15.11%),薄层细胞学涂片细胞数<5 000个的漏诊率(57.83%)远高于 细胞数>5 000个的漏诊率22.63%),联合TCT可以使筛查的漏诊率从20.19%降至13.38%。结论 细胞DNA定量分析是一种有效 的宫颈病变筛查手段,对宫颈高度鳞状上皮内病变及宫颈鳞状细胞癌的敏感性高于TCT,且可对ASCUS患者进行有效分流,其筛 查效果略优于TCT。但细胞DNA定量分析特异度低于TCT,且对宫颈腺癌的筛查漏诊率高。细胞DNA定量分析与TCT联合应用可 显著提高筛查的敏感性。

关键词: 细胞DNA定量分析, 液基细胞学, 宫颈病变

Abstract: Objective To determine the application value of quantitative detection of DNA in cervical lesion screening. Methods Retrospective analysis of 82 518 cases of cervical lesions was carried out. The sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of DNA quantification and ThinPrep cytology test(TCT)for the diagnosis of cervical lesions were compared with the results of biopsy. The accuracy of the two methods was evaluated by applying the receiver operating characteristic curve. Results The sensitivity of DNA quantification,TCT,and combined diagnosis was 77.37%,70.97%,and 90.24%,respectively, and the specificity was 65.59%,70.42%,and 45.06%,respectively. The sensitivity of cell DNA quantitative analysis was higher but the specificity was lower than that of TCT,while the sensitivity of combined diagnosis was the highest. In DNA quantitative analysis of patients with and without atypical squamous cells of undetermined significance(ASCUS),the positive rates of pathology were 42.71% and 12.5%, respectively. The misdiagnosis rate of cell DNA quantitative analysis for screening cervical adenocarcinoma(39.13%)was higher than that for screening cervical squamous cell carcinoma(15.11%). In a cytologic smear,the misdiagnosis rate of cells < 5 000(57.83%)was much higher than that of cells > 5 000(22.63%). However,a combined diagnosis with TCT could reduce the misdiagnosis rate from 20.19% to 13.38%. Conclusion Cell DNA quantification is more sensitive than TCT,but the specificity of cell DNA analysis is lower than that of TCT,and the screening rate for cervical adenocarcinoma is high. Quantitative DNA analysis combined with TCT can significantly improve the screening sensitivity.

Key words: DNA quantitative analysis, ThinPrep cytology test, cervical lesions

中图分类号: 

  • R737.33
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