Kim T J, Kim H S, Park C T, Park I S, Hong S R, Park J S, Shim J U
College of Medicine, Sungkyunkwan University, Seoul, 100-380, Korea.
Gynecol Oncol. 1999 May;73(2):292-8. doi: 10.1006/gyno.1999.5360.
The aim of this study was to evaluate the efficacy of the follow-up methods and results of atypical glandular cells of undetermined significance (AGUS) detected on cervicovaginal Pap smears.
From May 1991 to December 1996, we have performed 407, 451 cervicovaginal Pap smears, of which 326 patients were identified as AGUS. Of the 326 patients, 268 patients were followed by repeat Pap smears, colposcopy, cone biopsy, or endometrial curettage.
The incidence of AGUS on Pap smears is approximately 0.08%. The mean age of the patients was 43 years (range 22-79 years). The most common complaint was abnormal vaginal bleeding. The gross findings of the cervix were normal to mild erosion. The following past histories of patients could affect the AGUS results on Pap smear: 30 had cone biopsy, 21 had Pap smears on pregnancy and within 8 weeks after delivery or evacuation, 3 were on hormonal replacement therapy, 2 had intrauterine devices for contraception, and 5 were undergoing follow-up after treatment of cervical cancer. The benign lesions detected during follow-up periods were 6 microglandular hyperplasia of the cervix, 5 atypical squamous metaplasia of the cervix, 2 cervical endometriosis, 2 tubal metaplasia, 10 cervical myoma, 11 cervical polyps, 9 endometrial polyps, 3 uterine myoma, 1 pelvic endometriosis, 1 ovarian endometriosis, and 4 uterine adenomyosis. The premalignant or malignant lesions of the cervix were 4 low-grade squamous intraepithelial lesions, 24 high-grade squamous intraepithelial lesions, 8 glandular atypia/dysplasia, 5 adenocarcinoma in situ, 3 microinvasive adenocarcinoma, and 4 invasive adenocarcinoma. The neoplastic lesions of the uterus were 6 endometrial hyperplasia, 11 endometrial adenocarcinoma, 1 malignant mixed Müllerian tumor, and 1 metastatic endometrial adenocarcinoma. Sixty-seven (25%) of 268 patients followed up were identified as having clinically significant lesions of the cervix or uterus. The detection rates of abnormal lesions were 3.1% with repeated Pap smears (3/98), 28.4% with colposcopic-directed biopsy (31/109), 63.6% with cone biopsy (35/55), and 29.7% with endometrial curettage (19/64).
AGUS on Pap smears showed various benign and malignant lesions of the cervix or uterus. The clinicians must communicate with the pathologists regarding the patient's clinical information as well as the origin of the atypical glandular cells in Pap smears. We recommend that patients with AGUS on Pap smear should undergo immediate intensive diagnostic studies, including colposcopic-directed biopsy with endocervical curettage or cone biopsy, to detect cervical lesions and endometrial curettage to detect endometrial lesions.
本研究旨在评估宫颈阴道巴氏涂片检查中意义不明确的非典型腺细胞（AGUS）的随访方法及结果的有效性。
1991年5月至1996年12月，我们共进行了407451次宫颈阴道巴氏涂片检查，其中326例患者被诊断为AGUS。在这326例患者中，268例患者接受了重复巴氏涂片检查、阴道镜检查、锥形活检或子宫内膜刮除术进行随访。
巴氏涂片检查中AGUS的发生率约为0.08%。患者的平均年龄为43岁（范围22 - 79岁）。最常见的症状是阴道异常出血。宫颈大体检查结果正常至轻度糜烂。患者的以下既往史可能影响巴氏涂片检查中AGUS的结果：30例曾行锥形活检，21例在孕期及产后或清宫后8周内进行过巴氏涂片检查，3例接受激素替代治疗，2例放置宫内节育器避孕，5例在宫颈癌治疗后接受随访。随访期间发现的良性病变有6例宫颈微小腺体增生、5例宫颈非典型鳞状化生、2例宫颈子宫内膜异位症、2例输卵管化生、10例宫颈肌瘤、11例宫颈息肉、9例子宫内膜息肉、3例子宫肌瘤、1例盆腔子宫内膜异位症、1例卵巢子宫内膜异位症和4例子宫腺肌病。宫颈的癌前或恶性病变有4例低级别鳞状上皮内病变、24例高级别鳞状上皮内病变、8例腺体异型增生/发育异常、5例原位腺癌、3例微浸润腺癌和4例浸润性腺癌。子宫的肿瘤性病变有6例子宫内膜增生、11例子宫内膜腺癌、1例恶性混合性苗勒管肿瘤和1例转移性子宫内膜腺癌。在接受随访的268例患者中，67例（25%）被确定患有宫颈或子宫的临床显著病变。重复巴氏涂片检查的异常病变检出率为3.1%（3/98），阴道镜引导下活检为28.4%（31/109），锥形活检为63.6%（35/55），子宫内膜刮除术为29.7%（19/64）。
巴氏涂片检查中的AGUS显示出宫颈或子宫的各种良性和恶性病变。临床医生必须就患者的临床信息以及巴氏涂片中非典型腺细胞的来源与病理学家进行沟通。我们建议巴氏涂片检查发现AGUS的患者应立即接受强化诊断检查，包括阴道镜引导下活检及宫颈管刮除术或锥形活检以检测宫颈病变，以及子宫内膜刮除术以检测子宫内膜病变。
