外周血循环肿瘤细胞检测在早期子宫颈浸润癌筛查中的临床价值

陈志强; 米贤军; 刘君; 苏年华; 叶才果; 陈昂; 段立锋; 代新珍; 徐秀梅

外周血循环肿瘤细胞检测在早期子宫颈浸润癌筛查中的临床价值

Clinical Value of Peripheral Blood Circulating Tumor Cells Detection in Early Cervical Infiltrating Carcinoma Screening

摘要

摘要:
目的观察不同程度子宫颈病变患者的外周血循环肿瘤细胞（circulating tumor cell，CTC）的差异，评估CTC检测在早期子宫颈浸润癌筛查中的效能。
方法选择2015年12月至2017年10月中山市博爱医院、中山大学附属中山医院经组织病理和临床分期证实为子宫颈炎、子宫颈低级别与高级别鳞状上皮内病变（low-and high-grade intraepithelial lesions，LSIL、HSIL）、早期子宫颈浸润癌（4组）患者各63例，采用免疫磁珠阴性富集技术联合免疫荧光原位杂交技术（immunofluorescent in situ hybridization，imFISH）检测患者外周血CTC，分析4组患者CTC阳性率及数量差异，以组织病理诊断和临床分期结果为金标准，评价CTC检测结果阳性诊断早期子宫颈浸润癌的效能。
结果 ①子宫颈炎组、LSIL组、HSIL组、早期子宫颈浸润癌组患者CTC阳性率分别为0、0、19.05%、84.13%，总体差异有统计学意义（χ²=504.00，P<0.05）。早期子宫颈浸润癌组CTC阳性率高于其他组，与其他组相比差异有统计学意义（P<0.008 3）。HSIL组CTC阳性率与LSIL、子宫颈炎组相比差异有统计学意义（P<0.008 3）。②子宫颈炎组、LSIL组、HSIL组、早期子宫颈浸润癌组患者的CTC阳性数（中位数）分别为0、0、1个/ 4 mL、3个/ 4 mL。早期子宫颈浸润癌组CTC阳性个数高于其他组，与其他组相比差异有统计学意义（P<0.008 3）。HSIL组平均CTC阳性数与LSIL、子宫颈炎组相比差异有统计学意义（P<0.008 3）。③CTC检测阳性结果诊断早期子宫颈浸润癌的灵敏度、特异度、符合率、阳性预测值和阴性预测值分别为84.13%、93.65%、91.27%、81.54%和94.65%。
结论 CTC存在于HSIL和早期子宫颈浸润癌患者中，随着子宫颈病变程度的加重，CTC检测结果阳性率及数量均增加；CTC检测在早期子宫颈浸润癌筛查中具有一定的实用价值。

Abstract:
Objective To observe the difference of circulating tumor cells (CTC) in peripheral blood of patients with different degrees of cervical lesions, and to evaluate the effectiveness of CTC detection in screening early invasive cervical cancer.
Methods From December 2015 to October 2017, 63 cases of cervicitis, low-grade and high-grade intraepithelial lesions (LSIL, HSIL) and early invasive cervical cancer were confirmed by histopathological and clinical stages in Zhongshan Boai Hospital and Zhongshan Hospital Affiliated to Zhongshan University. The immunomagnetic bead negative enrichment technique combined with immunofluorescence was used. In situ hybridization (imFISH) was used to detect CTC in peripheral blood of patients. The positive rate and quantity of CTC in four groups were analyzed. The diagnostic efficacy of CTC in early invasive cervical cancer was evaluated based on the results of histopathological diagnosis and clinical staging.
Results ①The positive rates of CTC in cervicitis group, LSIL group, HSIL group and early invasive cervical cancer group were 0, 0, 19.05% and 84.13% respectively. The overall difference was statistically significant (χ²=504.00, P<0.05). The positive rate of CTC in early invasive cervical cancer group was higher than that in other groups (P<0.008 3). The positive rates of CTC in HSIL group were significantly different from those in LSIL group and cervicitis group (P<0.008 3). ②The average number (median) of CTC positive in cervicitis group, LSIL group, HSIL group and early invasive cervical cancer group was 0, 0, 1/4 mL, 3/4 mL, respectively. The average number of positive CTC in early invasive cervical cancer group was higher than that in other groups, and the difference was significant compared with other groups (P<0.008 3). The average number of CTC positive in HSIL group was significantly different from that in LSIL and cervicitis group (P<0.008 3). ③The sensitivity, specificity, coincidence rate, positive predictive value and negative predictive value of CTC positive results in the diagnosis of early invasive cervical cancer were 84.13%, 93.65%, 91.27%, 81.54% and 94.65%, respectively.
Conclusion CTC exists in patients with HSIL and early invasive cervical cancer. With the aggravation of cervical lesions, the positive rate and number of CTC test results increase. CTC detection in early invasive cervical cancer screening has a certain practical value in clinic.

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