ĐÁNH GIÁ CHỈ SỐ TĂNG SINH TẾ BÀO BẰNG KỸ THUẬT PHÂN TÍCH DÒNG CHẢY TẾ BÀO: TIỀM NĂNG ỨNG DỤNG TRONG SÀNG LỌC UNG THƯ CỔ TỬ CUNG

Abstract

Background: Cervical cancer is the fourth most common malignancy among women globally and a leading cause of cancer-related mortality in developing countries. While the Papanicolaou (Pap) test remains the standard method for cervical cancer screening, its sensitivity remains limited, particularly for detecting low- and intermediate-grade lesions. Recently, flow cytometry (FCM) has emerged as a potential adjunctive tool for cervical cancer screening due to its ability to assess cellular biological features, including the Cell Proliferation Index (CPI). Objectives: This study aims to evaluate the diagnostic value of CPI, determined by FCM, in classifying cervical cytological abnormalities and enhancing the effectiveness of cervical cancer screening. Method: A cross-sectional descriptive study was conducted on 202 liquid-based cytology (LBC) samples collected from Dai Phuoc General Clinic and University Medical Center Ho Chi Minh City – Branch 2, between September 2024 and April 2025. Pap test and high-risk human papillomavirus (HR-HPV) PCR results were retrospectively reviewed. CPI was analyzed using FCM on residual LBC samples. Results: CPI increased progressively with cytological abnormality severity (p < 0.001). The optimal CPI cut-off value was 14.51%, with a sensitivity of 88%, specificity of 73.75%, and area under the ROC curve (AUC) of 0.84 (95% CI: 0.77–0.92; p < 0.001) for detecting lesions greater than ASC-US. The Kappa agreement between FCM and Pap results was 0.34 and 0.37 in two classification settings, with observed concordance rates of 72.77% and 75.68%, respectively (p < 0.001). Conclusion: CPI effectively discriminates cervical cytological abnormalities, particularly in HR-HPV–positive women. Flow cytometry shows potential as a complementary tool to the Pap test, improving sensitivity in screening for precancerous cervical lesions.