Ronnett B M, Manos M M, Ransley J E, Fetterman B J, Kinney W K, Hurley L B, Ngai J S, Kurman R J, Sherman M E
Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Hum Pathol. 1999 Jul;30(7):816-25. doi: 10.1016/s0046-8177(99)90143-0.
We intensively reviewed 137 smears initially classified as atypical glandular cells of undetermined significance (AGUS) to refine cytological criteria for evaluating these cases, evaluate histological outcomes, and assess the value of human papillomavirus (HPV) DNA testing in management. Consenting, nonpregnant study participants were identified from a cohort of 46,009 women receiving routine Pap smear screening in a managed care setting. Colposcopy was performed on all women, and at least one histological sample was obtained from each. Review diagnoses were assigned to smears and biopsy specimens by two separate panels of pathologists. DNA testing for cancer-associated HPV types was performed on rinses of cytological samplers after a smear and thin-layer slide had been made. On review, 47 (34%) smears were reclassified as negative, 44 (32%) as AGUS, 30 (22%) as atypical squamous cells of undetermined significance (ASCUS), and 16 (12%) as squamous intraepithelial lesions (SIL). The 19 smears interpreted as high-grade intraepithelial lesions on review included 13 high-grade SIL (HSIL), two HSIL with AGUS, favor neoplastic (endocervical adenocarcinoma in situ [AIS]), and four AGUS, favor neoplastic (AIS). Review histological diagnoses were negative in 105 (77%), squamous or glandular atypia in four (3%), low-grade SIL (LSIL) in nine (7%), HSIL in 12 (9%), AIS in five (4%, including two with concurrent HSIL), and endometrial carcinoma in one (1%). HPV testing identified 11 (92%) of 12 women with histologically confirmed HSIL and all five with AIS (100%). A high-grade intraepithelial lesion or carcinoma is detected in approximately 14% of women with community-based diagnoses of AGUS who are referred for immediate evaluation. Use of refined cytological criteria and HPV DNA testing may permit improved management of women with AGUS.
我们对137份最初分类为意义不明确的非典型腺细胞（AGUS）涂片进行了深入审查，以完善评估这些病例的细胞学标准，评估组织学结果，并评估人乳头瘤病毒（HPV）DNA检测在管理中的价值。从在管理式医疗环境中接受常规巴氏涂片筛查的46,009名女性队列中确定了同意参与研究的非妊娠研究参与者。对所有女性进行了阴道镜检查，并从每个人身上获取了至少一份组织学样本。由两个独立的病理学家小组对涂片和活检标本进行复查诊断。在制作涂片和薄层玻片后，对细胞学采样器的冲洗液进行癌症相关HPV类型的DNA检测。复查时，47份（34%）涂片被重新分类为阴性，44份（32%）为AGUS，30份（22%）为意义不明确的非典型鳞状细胞（ASCUS），16份（12%）为鳞状上皮内病变（SIL）。复查时被解释为高级别上皮内病变的19份涂片包括13份高级别SIL（HSIL）、2份伴有AGUS的HSIL（倾向于肿瘤性，宫颈原位腺癌[AIS]）和4份AGUS（倾向于肿瘤性，AIS）。复查组织学诊断为阴性的有105例（77%），鳞状或腺性非典型增生4例（3%），低级别SIL（LSIL）9例（7%），HSIL 12例（9%），AIS 5例（4%，包括2例合并HSIL），子宫内膜癌1例（1%）。HPV检测在12例经组织学证实为HSIL的女性中检测出11例（92%），在所有5例AIS女性中均检测出（100%）。在以社区为基础诊断为AGUS并被转诊进行立即评估的女性中，约14%检测出高级别上皮内病变或癌。使用完善的细胞学标准和HPV DNA检测可能会改善对AGUS女性的管理。
