DNA倍体联合人乳头瘤病毒检测对宫颈病变筛查的临床价值

Clinical value of DNA ploidy analysis combined with HPV detection and thinprep liquid-based cytology test for screening of early cervical cancer

关键词:  DNA定量分析  液基细胞学检测  人乳头瘤病毒检测  宫颈癌  早期筛查

Key words:  DNA quantitative analysis  liquid-based cytology test  human papilloma virus testing  cervical cancer  early screening

摘要:

目的 比较DNA倍体分析联合人乳头瘤病毒（HPV）与液基细胞学检测（TCT）对早期宫颈癌筛查的敏感性和特异性，探讨DNA倍体分析在宫颈病变筛查中的临床价值。方法 选取2018年上海市浦东新区妇幼保健院进行宫颈癌筛查的患者，先进行DNA倍体分析；发现异常后再进行TCT、HPV联合检测，并分别与宫颈病变的活检病理符合率相比较。结果 共完成9850例宫颈标本的DNA倍体检查，检查异常者有1306例，经TCT检测及HPV联合检测后临床共完成阴道镜检查并活检送病理者968例。DNA倍体分析异常并行活检的正常宫颈组织、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)、宫颈癌的比例分别为35.5%（344/968）、44.7%（433/968）、18.2%（176/968）、1.5%（15/968）。DNA倍体异常细胞≥3个组的LSIL及以上的检出率为81.8%（432/528），与TCT对LSIL及以上的检出率（83.5%，685/701）比较，差异无统计学意义（P＞0.05）。单独DNA倍体异常细胞≥3个组的灵敏度为69.2%（432/624），联合HPV DNA检查后对LSIL及以上的检出率提高到95.8%（183/191），两组比较有统计学差异（P＜0.05），而特异度变化无差异（P＞0.05）。结论 DNA倍体联合HPV检测，在特异度基本不变的情况下能够提高宫颈病变筛查的灵敏度，值得临床推广。

Abstract:

Objective To assess the clinical value of DNA ploidy analysis combined with human papilloma virus (HPV) detection and thinprep liquid-based cytology test （TCT） for screening of early cervical cancer. Methods A total of 9850 women undergoing screening for cervical cancer in hospital from January to December 2018 were enrolled in this study. DNA ploidy analysis was performed, for those with DNA ploidy abnormalities, TCT and HPV detection were carried out afterward. The clinical value of DNA analysis combined with HPV detection and TCT in screening of cervical cancer was assessed with the pathological results of biopsy samples as gold standard. Results Among 9850 cases of DNA ploidy analysis 1306 were abnormal, of which 968 cases underwent colposcopic examination, HPV detection and TCT, the biopsy and pathological examination were also performed. The pathological results confirmed that the percentages of normal cervical tissue, LSIL, HSIL and cervical cancer were 35.5% (344/968), 44. 7% (433/968), 18.2%(176/968), 1.5% (15/968), respectively. The detection rates of LSIL lesions and above in DNA ploidy abnormal cells ≥3 group and TCT group were 81. 8% (432/528) and 83.5% (685/701)（P＞0.05）.The sensitivity of DNA ploidy abnormal cells ≥3 was 69.2% (432/624), and if combined with HPV detection it increased to 95.8%（183/19）(P＜0.05), but there was no difference in specificity (P＞0.05). Conclusion DNA ploidy analysis combined with HPV detection can improve the sensitivity of early cervical cancer screening without affecting specificity, which is worthy of clinical promotion.