探讨宫颈DNA倍体分析联合宫颈细胞学检查，在宫颈癌筛查中的应用价值。

采用回顾性研究方法，选取2016年1月1日至10月31日，在四川大学华西第二医院门诊进行宫颈癌筛查的862例女性为研究对象。对其进行宫颈DNA倍体分析、新柏液基薄层细胞学检查(TCT)，对宫颈DNA倍体分析或TCT结果呈阳性者，均进行阴道镜检查，并取宫颈组织进行活组织病理学检查，以此结果作为诊断宫颈病变的"金标准"，计算宫颈DNA倍体分析、TCT及2种方法联合筛查宫颈癌及其癌前病变的敏感度、特异度、阳性预测值和阴性预测值，比较这3种筛查方案的准确性。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①本组862例受试者的宫颈活组织病理学检查诊断结果为：正常宫颈组织为655例(76.0%)、宫颈上皮内瘤变(CIN)1～3级分别为109例(12.7%)、45例(5.2%)及39例(4.5%)，宫颈癌为14例(1.6%)，CIN2＋(宫颈病变≥CIN2)检出率为11.4%(98/862)。宫颈DNA倍体分析结果的阳性率为32.5%(280/862)，CIN2＋检出率为10.9%(94/862)。TCT结果的阳性率为31.6%(272/862)，CIN2＋检出率为10.8%(93/862)。宫颈DNA倍体分析联合TCT筛查结果的阳性率为35.7%(308/862)，CIN2＋检出率为11.0%(95/862)。②宫颈DNA倍体分析、TCT及2种方法联合筛查CIN2＋的敏感度分别为95.9%(94/98)、94.9%(93/98)与96.9%(95/98)，特异度分别为75.7%(578/764)、76.6%(585/764)与72.1%(551/764)，阳性预测值分别为33.6%(94/280)、34.2%(93/272)与30.8%(95/308)，阴性预测值分别为99.3%(578/582)、99.2%(585/590)与99.5%(551/554)。宫颈DNA倍体分析与TCT联合筛查CIN2＋的敏感度、阴性预测值，均分别高于这2种方案单独筛查。

宫颈DNA倍体分析与TCT联合筛查宫颈癌及其癌前病变，可提高筛查结果的准确性。因本研究仅为回顾性研究，这2种方案联合筛查宫颈癌及其癌前病变的价值，仍有待大样本、多中心、前瞻性随机对照研究予以证实。

To explore the screening values of cervical DNA ploidy analysis combined with cervical cytology test for cervical cancer.

A total of 862 women who underwent cervical cancer screening in West China Second University Hospital, Sichuan University from January 1 to October 31, 2016 were selected as research subjects by retrospective study method. All participants received cervical DNA ploidy analysis and cervical ThinPrep liquid-based cytology test (TCT). Those who were positive for cervical DNA ploidy analysis or TCT were examined by colposcopy, and cervical tissues were taken for pathological examination. Cervical biopsy results were taken as the " gold standard" . The sensitivities, specificities, positive predictive values and negative predictive values of three screening methods including cervical DNA ploidy analysis, TCT, and the combination of these two methods for screening cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+ ). The screening values of these three screening methods for CIN2+ were compared. The procedures in this study were in line with the requests of the World Medical Association Declaration of Helsinki revised in 2013.

①The histopathological diagnosis results of those 862 subjects in this study were as follows. There were 655 cases (76.0%) of normal cervical tissue, 109 cases (12.7%) of CIN1, 45 cases (5.2%) of CIN2, 39 cases (4.5%) of CIN3, 14 cases (1.6%) of cervical cancer, and the detection rate of CIN2+ was 11.4% (98/862). The results of cervical DNA ploidy analysis showed that there were 280 cases (32.5%) of subjects with positive results, among whom 94 cases were CIN2+ , and the detection rate of CIN2+ was 10.9% (94/862). The results of TCT showed that 272 cases (31.6%) with positive results of TCT were detected, among whom 93 cases were CIN2+ , and detection rate of CIN2+ was 10.8% (93/862). The cervical DNA ploidy analysis combined with TCT screening results showed that 308 cases (35.7%) were with positive results, among whom 95 cases were CIN2+ , and the detection rate of CIN2+ was 11.0% (95/862). ② Sensitivities of cervical DNA ploidy analysis, TCT and the combination of those two methods for the screening of CIN2+ were 95.9% (94/98), 94.9% (93/98) and 96.9% (95/98), respectively, and specificities were 75.7% (578/764), 76.6% (585/764) and 72.1% (551/764), respectively, and positive predictive values were 33.6% (94/280), 34.2% (93/272) and 30.8% (95/308), respectively. Negative predictive values were 99.3% (578/582), 99.2% (585/590) and 99.5% (551/554), respectively. Sensitivity and negative predictive value of the combination of cervical DNA ploidy analysis and TCT for the screening of CIN2+ both were higher than those of the two methods alone.

Screening values of cervical DNA ploidy analysis combined with TCT for cervical precancerous lesions and cervical cancer are superior to those two methods alone, and the combination screening method can improve the screening accuracy rate for cervical lesions. Because this study is just a retrospective study, the screening values of the combination of these two methods in screening for cervical precancerous lesions and cervical cancer remains to be confirmed by large-sample, multicenter, prospective randomized controlled trials.