摘要目的 用荧光原位杂交(FISH)技术检测端粒酶RNA基因(TERC)在宫颈上皮内瘤变(CIN)和宫颈鳞状细胞癌(SCC)组织中的扩增,探讨其用于SCC筛查及CIN诊断的可行性及实际意义.方法 选取手术切除及活检的子宫颈组织标本196例,有效样本150例,采用FISH技术在石蜡包埋组织芯片上检测TERC基因的扩增情况.结果 150例组织芯片样本中,正常宫颈鳞状上皮24例,CIN 78例(CIN Ⅰ级25例,Ⅱ级21例,Ⅲ级32例),SCC 48例.正常宫颈鳞状上皮组织中TERC基因无扩增,从CIN Ⅰ级到SCC组织中,TERC基因的扩增率依次为8.0%(2/25)、47.6%(10/21)、71.9%(23/32)和87.5%(42/48),差异有统计学意义(P＜0.05).组间两两比较:正常宫颈鳞状上皮与CINⅡ级、Ⅲ级、SCC组,组间比较差异均有统计学意义(P＜0.05);CIN Ⅰ级与CINⅡ级、Ⅲ级及SCC组组间比较,差异有统计学意义(P＜0.05);CINⅡ级组与SCC组相比,差异有统计学意义(P＜0.05).正常宫颈鳞状上皮与CIN Ⅰ级组、CINⅡ级与Ⅲ级组、CINⅢ级与SCC组,组间差异均无统计学意义(P＞0.05).高度癌前病变(CINⅡ～Ⅲ级)与低度癌前病变(CIN Ⅰ级)的TERC基因扩增结果:25例CIN Ⅰ级病变中,2例扩增,23例不扩增;53例CINⅡ～Ⅲ级病变中,33例扩增,20例不扩增.经公式计算,敏感性为62.3%、特异性为92.0%、准确度为71.8%、阳性预测值为94.3%、阴性预测值为53.5%.结论 在石蜡包埋CIN及SCC组织切片上应用FISH技术进行TERC基因检测,方法可行,结果可靠;可作为辅助CINⅡ级的诊断;TERC基因扩增可以预测CIN发展为癌的风险,具有一定的实用价值.

abstractsObjective To explore the feasibility and practical value of fluorescence in situ hybridization (FISH) detection of TERC gene amplification in cervical intraepithelial lesions (CIN) and squamous cell carcinoma (SCC). Methods Tissue microarray was constructed to cover 150 cases of various cervical conditions, including 24 cases of normal cervical mucosa, 78 cases of CINs ( CIN Ⅰ , 25 cases; CIN Ⅱ , 21 cases and CIN Ⅲ, 32 cases) and 48 cases of SCC. FISH was used to detect TERC gene amplification. Results TERC gene amplification was detected in 8% (2/25) CIN Ⅰ , 47.6% ( 10/21 )CIN Ⅱ, 71.9% (23/32) CIN Ⅲ and 87.5% (42/48) SCC. There were significant differences among these groups (P ＜ 0.05 ). The amplification rates of TERC gene in SCC, CIN Ⅲ and CIN Ⅱ were significantly higher than those of normal cervical epithelium and CIN Ⅰ ( P ＜ 0.05 ). Significant differences were also observed among CIN Ⅰ and CIN Ⅱ , CIN Ⅲ and SCC ( P ＜ 0.05 ), and between CIN Ⅱ and SCC(P ＜0.05). There were no significant differences between normal cervical epithelium and CIN Ⅰ , CIN Ⅱ and CIN Ⅲ, and between CIN Ⅲ and SCC (P ＞ 0.05 ). FISH detection of amplification of TERC gene in CIN Ⅰ and CIN Ⅱ -Ⅲ demonstrated the following statistics: sensitivity of 62. 3%, specificity of 92.0%,accuracy of 71.8%, positive and negative predictive values of 94.3% and 53.5%, respectively.Conclusions FISH detection is a reliable method in detecting TERC gene amplification using paraffin tissue sections. When histological evaluation becomes difficult, TERC amplification detectable by FISH may offer a diagnostic distinction of CIN Ⅰ from CIN Ⅱ. Moreover, TERC amplification may be used as a biomarker in predicting CIN progression to invasive cancer.