标题：DNA倍体细胞检测与宫颈液基细胞学检查在宫颈病变筛查中的应用

      作者：初虹，余志英，邢娟，张小军，滕国召    深圳大学第一附属医院(深圳市第二人民医院)妇科，广东 深圳 518035

      卷次： 2020年31卷14期

      【摘要】 目的 对比DNA倍体细胞检测(DNA-ICM)与宫颈液基细胞学检查(TCT)在宫颈病变筛查中的优缺点。方法 回顾性分析2016年1月至2017年4月在深圳市第二人民医院妇科门诊同时进行 DNA-ICM和TCT筛查的12 753例患者的临床资料，其中198例因两种筛查任一筛查结果阳性，或HPV高危分型(+)，或HPV高危分型(-)但妇科检查宫颈有可疑病灶者，故行阴道镜下宫颈活检。病理结果按慢性炎症(单纯炎症、湿疣样变)、低度病变(LSIL：CINⅠ)、高度病变(HSIL：CINⅡ-Ⅲ)及宫颈癌进行划分。分析两种方法在不同病理分类的灵敏度和特异度的差异。结果 (1)活检病理以慢性宫颈炎为阴性结果，以LSIL (CINI)及其以上级别病变为阳性结果，两种方法比较，DNA-ICM灵敏度为93.5% (87/93)，优于TCT的灵敏度69.9% (65/93)，差异有统计学意义(P<0.05)；DNA-ICM特异度为20.0% (21/105)，低于TCT的特异度35.2% (37/105)，差异有统计学意义(P<0.05)；(2)对不同病理分类进行分层分析，DNA-ICM在湿疣样变、LSIL和HSIL中的阳性率分别为87.5% (49/56)、90.2% (37/41)和95.8% (46/48)，明显高于TCT的 64.2% (36/56)、63.0% (26/41)和72.9% (35/48)，差异均有统计学意义(P<0.05)；而在单纯炎症及宫颈癌中，DNA-ICM的阳性率分别为 71.4% (35/49)和100% (4/4)，与TCT的65.3% (32/49)和100% (4/4)结果相近，差异均无统计学意义(P>0.05)。结论 对LSIL及其以上级别病变，DNA-ICM较TCT的敏感度高，虽然特异度降低，但可结合其他检查以弥补；同时DNA-ICM对湿疣样变、LSIL、HSIL的阳性率明显高于TCT，而对于单纯炎症及宫颈癌的阳性率又不低于TCT，故DNA-ICM可作为比TCT更敏感的宫颈癌筛查方法。
      【关键词】 DNA倍体细胞检测；DNA细胞计数成像；宫颈液基细胞学检查；低级别鳞状上皮内病变；高级别鳞状上皮内病变；宫颈癌
      【中图分类号】 R711.74 【文献标识码】 A 【文章编号】 1003—6350（2020）14—1836—04

Application of DNA image cytometry compared with ThinPrep cytologic test in the screening of cervical lesions.CHU Hong, YU Zhi-ying, XING Juan, ZHANG Xiao-jun, TENG Guo-zhao.
Department of Gynecology, the First AffiliatedHospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen 518035, Guangdong, CHINA
【Abstract】 Objective To compare DNA image cytometry (DNA-ICM) with ThinPrep cytologic test (TCT) inthe screening of cervical lesions. Methods The clinical data of 12 753 outpatients, who were performed both DNA im-age cytometry (DNA-ICM) and ThinPrep cytologic test (TCT) from January 2016 to April 2017 in Department of Gyne-cology, the First Affiliated Hospital of Shenzhen University, were retrospectively analyzed. Among the patients, 198 cas-es, who had positive DNA-ICM or TCT results, or HPV high risk classification (+), or HPV high risk classification (-)but with suspected cervical lesions in gynecological examination, underwent cervical biopsy on suspected lesions undercolposcope. The pathological results were classified as chronic inflammation (single inflammation and condyloma-likelesions), low-grade squamous intraepithelial lesions (LSIL: cervical intraepithelial neoplasiaⅠ, CINⅠ), high-grade squa-mous intraepithelial lesions (CINⅡ and CINⅢ) and cervical cancer. The sensitivity and specificity of DNA-ICM andTCT in different pathological classifications were analyzed. Results (1) When taking LSIL (CINⅠ), HSIL (CINⅡ andCINⅢ), and cervical cancer as positive results, while chronic inflammation (single inflammation and condyloma-like le-sions) as negative results, the sensitivity was 93.5% (87/93) of DNA-ICM versus 69.9% (65/93) of TCT, and the specifici-ty was 20.0% (21/105) versus 35.2% (37/105) (all P<0.05). (2) Hierarchical analysis of different pathological classifica-tion showed that the positive rates of DNA-ICM in condyloma-like lesions, LSIL and HSIL were 87.5% (49/56),90.2% (37/41), 95.8% (46/48), respectively, which were significantly higher than corresponding 64.2% (36/56), 63.0%(26/41), and 72.9% (35/48) in TCT (all P<0.05). In single inflammation and cervical cancer, the positive rates were 71.4%(35/49) and 100.0% (4/4) of DNA-ICM versus 65.3% (32/49) and 100.0% (4/4) of TCT (all P>0.05). Conclusion InLSIL and HSIL, DNA-ICM is more sensitive but less reliable than TCT. Combining other methods should be consideredto improve the specificity of DNA-ICM. Overall, the positive rates of DNA-ICM in condyloma-like lesions, LSIL andHSIL are significantly higher than those of TCT, while those of DNA-ICM and TCT are similar in single inflammationand cervical cancer. Therefore, DNA-ICM provides a more sensitive method for the screening of cervical cancer.
      【Key words】 DNA ploidy cell detection; DNA image cytometry (DNA-ICM); ThinPrep cytologic test (TCT);Low-grade squamous intraepithelial lesion (LSIL); High-grade squamous intraepithelial lesion (HSIL); Cervical cancer