摘要
目的探讨基于细胞块技术p16/Ki-67双染对非典型鳞状上皮细胞(ASC-US)/低级别鳞状上皮内病变(LSIL)患者的宫颈上皮内瘤变(CIN)2级以上(≥CIN2)的诊断价值。方法收集2021年1月至2021年12月北京市海淀区妇幼保健院收治的222例子宫颈炎患者,均接受阴道镜活检、DNA倍体分析和高危人乳头瘤病毒(HR-HPV)检测,细胞学结果均为ASC-US/LSIL病例,对患者剩余的液基细胞学(LBC)标本进行基于细胞块技术的p16/Ki-67双染,绘制受试者操作者特征(ROC)曲线比较细胞块p16/Ki-67双染与DNA倍体分析和HR-HPV对≥CIN2病变的诊断价值。结果细胞块p16/Ki-67双染Kappa值为0.835,与活检病理诊断结果高度一致。细胞块p16/Ki-67双染ROC曲线下面积(AUC)为0.900(特异性和敏感度分别为94.16%和85.45%),HR-HPV检测AUC为0.557(特异性和敏感度分别为13.17%和98.18%),DNA倍体分析AUC为0.583(特异性和敏感度分别为32.93%和83.64%);细胞块p16/Ki-67双染AUC显著高于HR-HPV检测(Z=11.387、P<0.001)和DNA倍体分析(Z=7.476、P<0.001),差异有统计学意义。与HR-HPV检测和DNA倍体分析相比,细胞块p16/Ki-67双染NRI值分别为1.470(95%CI:1.246~1.470、P<0.001)和1.278(95%CI:1.049~1.278、P<0.001);IDI值分别为0.609(95%CI:0.525~0.692、P<0.001)和0.633%(95%CI:0.554~0.713,P<0.001)。结论基于细胞块p16/Ki-67双染对于≥CIN2患者的正确分类有更好的预测,是ASC-US/LSIL患者分流的良好方法,可有效避免过度诊断和治疗。
Objective To investigate the diagnostic value of p16/Ki-67 double staining based on cell block technology for cervical intraepithelial neoplasia(CIN)higher than grade 2(≥CIN2)for patients with atypical squamous cells of undetermined significance(ASC-US)/low-grade squamous intraepithelial lesions(LSIL).Methods From January 2021 to December 2021,a total of 222 patients with cervicitis who underwent colposcopy biopsy,DNA ploidy analysis and high risk human papillomarirus(HR-HPV)testing were selected from Beijing Haidian Maternal and Child Health Hospital.Cytological results of all cases were ASC-US/LSIL.The remaining liquid based cytology(LBC)specimens of patients were stained with p16/Ki-67 double staining based on cell block technology,and the diagnostic value of p16/Ki-67 double staining compared with DNA ploidy analysis and HR-HPV for≥CIN2 lesions were analyzed by receiver operating characteristic curve(ROC).Results The Kappa value of p16/Ki-67 double staining in cell block was 0.835,which was highly consistent with the pathological diagnosis of biopsy.The area under ROC(AUC)of p16/Ki-67 double staining was 0.900(the specificity and sensitivity were 94.16%and 85.45%,respectively),which was significantly higher than that of HR-HPV testing(AUC was 0.557,with the specificity and sensitivity were 13.17%and 98.18%,respectively)(Z=11.387,P<0.001)and DNA ploidy analysis(AUC was 0.583,with the specificity and sensitivity were 32.93%and 83.64%,respectively)(Z=7.476,P<0.001),with significant differences.Compared with HR-HPV testing and DNA ploidy analysis,the NRI values of p16/Ki-67 double staining were 1.470(95%CI:1.246-1.470,P<0.001)and 1.278(95%CI:1.049-1.278,P<0.001),respectively.The IDI values were 0.609(95%CI:0.525-0.692,P<0.001)and 0.633(95%CI:0.554-0.713,P<0.001),respectively.Conclusions The p16/Ki-67 double staining based on cell block has a better predictive ability for the correct classification of patients≥CIN2,and is a good method for the triage of patients with ASC-US/LSIL,which can effectively avoid the over-diagnosis and treatment.
作者
孙笑非
顾依群
王爱春
王荔
孟凡凡
王军
卢利娟
Sun Xiaofei;Gu Yiqun;Wang Aichun;Wang Li;Meng Fanfan;Wang Jun;Lu lijuan(Department of Pathology,Haidian Maternal and Child Health Hospital,Beijing 100080,China)
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2022年第6期418-425,共8页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
北京市海淀区卫生健康发展科研培育计划(No.HP2021-31-10301)
关键词
宫颈癌筛查
p16/Ki-67双染
不明的非典型鳞状上皮细胞
低级别鳞状上皮内病变
细胞块
宫颈上皮内瘤变
Cervical cancer screening
p16/Ki-67 double staining
Atypical squamous cells of undetermined significance
Low-grade squamous intraepithelial leasion
Cell block
Cervical intraepithelial neoplasia
