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To establish if measurements of DNA ploidy could be used to assist cytopathologists and cytotechnologists in population based cervical cancer screening programs in countries where manually reading the slides is impossible due to the lack of sufficient skilled cytotechnologists. The goal of such program is to identify only clinically significant lesions, i.e. those where a clinical intervention to remove the lesion is required immediately.
A total of 9905 women were enrolled in the study. Cervical samples were taken with a cervix brush that was then placed into a fixative solution. The cells were separated from mucus by mechanical and chemical treatment and then deposited onto microscope slides by a cytocentrifuge. Two slides were prepared from each case; one slide was stained by Papanicolaou stain for manual cytology examination, while the other slide was stained by a DNA specific stain. The latter slide was used to determine the relative amount of DNA in the cell nuclei.
A total of 876 women were followed by colposcopy examination where biopsies were taken from the visible lesions or from suspicious areas and histopathology diagnosed 459 as normal or benign cases, 325 as CIN1, 36 as CIN2, 25 as CIN3/CIS, and 31 as invasive cancer. Of these 876 cases, manual cytology called 655 normal or ASCUS, 197 as LSIL, 16 cases as HSIL, and 8 as cancer. DNA measurements found 704 cases having no cells with DNA greater than 5c, 98 cases where there were 1 or 2 cells having DNA amount greater than 5c, and 74 cases where there were 3 or more cells having DNA amount greater than 5c. If manual cytology were to be used to refer all cases of HSIL and cancer to colposcopy and biopsy, 23 lesions that had to be removed would have been discovered (2 CIN2, 11 CIN3/CIS, and 10 cancers), for a sensitivity of 25.0+/-5.2% at specificity of 99.9+/-0.1%. If DNA assisted cytology were to be used instead, and all cases having 3 or more cells with DNA amount greater than 5c were to be referred to colposcopy and biopsy, then 50 lesions that had to be removed would have been discovered (10 CIN2, 15 CIN3/CIS and 25 cancers) for the sensitivity of 54.3+/-6.2% at specificity of 96.9+/-0.6%.
The study suggests that screening for high grade cervical neoplastic lesions and cervical cancer by DNA assisted cytology could be implemented with minimal use of skilled cytotechnologists, at least in those countries where it would be difficult to introduce population based screening for cervical cancer due to the lack of availability of such skilled cytotechnologists.
检测宫颈癌和高级别的肿瘤性病变液基采样准备和使用自动图像分析的DNA测量的组合。
孙小蓉,汪建,Garner D, Palcic B.
摘要
目的:
要在那些人工阅读玻片是不可能的国家,因为缺乏足够的熟练细胞学技师细胞学医生和细胞学技师,建立DNA倍体的测量可用于协助细胞学医生和细胞学技师为人口基础的子宫颈癌筛查的方案。这一方案的目标是确定有临床意义的病变,即那些需要立即用临床干预去除的病变。
研究与方法:
一个共9905名妇女参加了这项研究。用宫颈刷取下宫颈的样本放置在固定液内。细胞学工作人员通过机器离心将细胞从粘液中分离出来,然后沉淀在载玻片上面。每个病例制做两张玻片,一张玻片是由巴氏染色方法染色,人工阅读细胞学,另一张玻片是由DNA的特定染色方法染色。后者的玻片是用来测定细胞核中的DNA相对含量。
结果:
共有876名妇女被随访阴道镜检查,活检可见病变或可疑的地方和病理组织学诊断为正常或良性病例459例,325例为CIN1,36例为CIN2,25例为CIN3/CIS,和31例为浸润癌。其中876例病例中,常规细胞学655例为正常或ASCUS,197例为LSIL,16例为HSIL,8例为宫颈癌。 DNA测量发现704例没有DNA含量大于
结论:
这项研究表明,通过应用DNA辅助细胞学检查筛查出高级别宫颈肿瘤性病变和子宫颈癌的筛查方案。在这些由于缺少熟练的细胞学技师,很难引进熟练的细胞学技师为人口宫颈癌基础筛查的国家是可以实施,
关键词
子宫颈上皮内瘤样病变( CIN ),液体样品制备,图像分析,DNA倍体,细胞学技师短缺,细胞学,敏感性,特异性,浸润性癌
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