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目的分析西北地区女性宫颈癌的筛查结果,并探讨DNA倍体分析技术在宫颈癌筛查中的应用价值,旨在为宫颈癌的防治提供参考依据。方法选取2014年4月-2016年3月西北地区医院收治的需要进行宫颈癌筛查的患者23 000例进行宫颈癌筛查。对其进行常规检查(宫颈刮片细胞学检查、阴道镜、宫颈和宫颈管活组织检查)和液基薄层细胞学检测技术检查(液基薄层制片、硫堇-Feulgen染色、DNA倍体分析)。分析患者的DNA倍体检查结果和宫颈癌筛查结果,并计算病理诊断标准、不同检查方式在宫颈癌筛查中的相对敏感度、相对特异度、阳性预期值和阴性预期值。结果排除2 905例需要在3~6个月后复查的患者,共有20 095例符合研究标准。细胞DNA倍体分析技术显示,20 095例患者中有18 970例未见异倍体细胞和异常增生,故将其判定为阴性,阴性率为94.40%;1 125例见异倍体细胞和异常增生者为阳性,阳性率为5.60%。经病理诊断标准判断,1 125例患者中,共有227例疑似宫颈癌病理改变,其中阴性或炎症71例、CINⅠ47例、CINⅡ62例、CINⅢ38例、宫颈癌9例;在常规检查中未见上皮内病变细胞或恶性细胞(NILM)36例、不明确非典型鳞状细胞(ASCUS)97例、低度鳞状上皮内病变(LSIL)54例、高度鳞状上皮内病变(HSIL)40例;在DNA倍体分析中阴性24例、可疑21例、阳性182例;在HPV检查中,阳性120例、阴性107例。常规检查的相对敏感度、相对特异度、阳性预期值、阴性预期值分别为71.79%、78.88%、23.44%、74.56%;细胞DNA倍体分析的相对敏感度、相对特异度、阳性预期值、阴性预期值分别为89.55%、71.46%、55.58%、95.08%;宫颈HPV检测的相对敏感度、肿瘤细胞相对特异度、阳性预期值、阴性预期值分别为92.67%、84.19%、27.70%、92.31%。结论 DNA倍体分析技术能够提高宫颈癌的阳性检出率,进一步提高宫颈癌常规检查结果的准确性,为临床诊断、治疗及预防宫颈癌提供科学依据,减少宫颈癌发病几率或延缓宫颈癌进展趋势。
Objective To analyze the screening results of cervical cancer in women in Northwest China and to explore the value of DNA ploidy analysis in screening cervical cancer so as to provide a reference for the prevention and treatment of cervical cancer. Methods Twenty-three thousand cases of cervical cancer who underwent cervical cancer screening in the Northwest Hospital from April 2014 to March 2016 were selected for cervical cancer screening. They were routinely examined (cervical smear cytology, colposcopy, cervical and cervical canal biopsies) and liquid-based thin-layer cytological examination (liquid-based TLC, thionine-Feulgen staining, Body analysis). The results of DNA ploidy test and cervical cancer screening were analyzed. The relative sensitivity, relative specificity, positive predictive value and negative predictive value of pathological diagnostic criteria and different examinations in cervical cancer screening were calculated. Out of 2 905 patients who needed to be reviewed after 3 to 6 months, a total of 20 095 patients met the criteria of the study. Cell DNA ploidy analysis showed that 18 970 out of 20 095 patients showed no abnormal somatic cells and abnormal proliferation, so it was negative, the negative rate was 94.40%; 1 125 cases of aneuploid cells and abnormalities Hyperplasia was positive, the positive rate was 5.60%. Judged by the pathological diagnostic criteria, a total of 1 125 cases of 227 cases of suspected pathological changes of cervical cancer, including 71 cases of negative or inflammation, CIN Ⅰ 47 cases, CIN Ⅱ 62 cases, CIN Ⅲ 38 cases of cervical cancer in 9 cases; no routine examination of intraepithelial 36 cases of diseased or malignant cells (NILM), 97 cases of unclear atypical squamous cell (ASCUS), 54 cases of low grade squamous intraepithelial lesion (LSIL) and 40 cases of highly squamous intraepithelial lesion (HSIL) In DNA ploidy analysis, 24 were negative, 21 were suspicious, and 182 were positive. In the HPV test, 120 were positive and 107 were negative. The relative sensitivity, relative specificity, positive predictive value and negative predictive value of routine examination were 71.79%, 78.88%, 23.44% and 74.56% respectively. The relative sensitivity, relative specificity and positive predictive value of DNA ploidy analysis, The negative predictive value of HPV was 89.55%, 71.46%, 55.58% and 95.08% respectively. The relative sensitivity of cervical HPV detection, the relative specificity of tumor cells, positive predictive value and negative predictive value were 92.67%, 84.19%, 27.70% and 92.31 %. Conclusion DNA ploidy analysis can improve the positive detection rate of cervical cancer, further improve the accuracy of routine cervical cancer examination, provide a scientific basis for clinical diagnosis, treatment and prevention of cervical cancer, reduce the incidence of cervical cancer or delay the progression of cervical cancer trend.