绝经后女性意义不明确的非典型腺细胞的临床意义

Clinical significance of atypical glandular cells of undetermined significance in postmenopausal women.

作者信息

Chhieng D C, Elgert P, Cohen J M, Cangiarella J F

机构信息

Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35249-6823, USA.

出版信息

Cancer. 2001 Feb 25;93(1):1-7.

PMID:11241259

Abstract

BACKGROUND

Glandular atypia in Papanicolaou (Pap) smears from postmenopausal women is encountered frequently. This finding can be the result of artifactual alterations such as drying artifacts and inflammatory changes or may represent a squamous or glandular, preneoplastic or neoplastic process. Therefore, it is important to determine the clinical implication of a diagnosis of atypical glandular cells of undetermined significance (AGUS) in postmenopausal patients.

METHODS

A total of 30,036 Pap smears were obtained from postmenopausal women between 1995 and 1997. Among these smears, 154 (0.51%) had a diagnosis of AGUS. Follow-up was available for 133 patients (86.4%); 110 patients (82.7%) had histologic follow-up (including cervical biopsy, endocervical [EC] curettage, and/or endometrial [EM] biopsy) and 23 patients (17.3%) had repeat smears.

RESULTS

Thirty-six of 110 patients (32.7%) were found to have a clinically significant lesion (defined as a preneoplastic or neoplastic, glandular or squamous lesion) on subsequent histologic follow-up. Nineteen patients (53%) had glandular lesions (15 EM adenocarcinoma [ACA] cases, 2 EC ACA cases, 1 EC adenocarcinoma is situ case, and 1 EM hyperplasia case). Seventeen patients (47%) had a squamous intraepithelial lesion (SIL) (6 cases of low-grade SIL, 9 cases of high-grade [HGIL], and 2 cases of squamous cell carcinoma). Among those patients with repeat Pap smears, five patients had persistent AGUS/atypical squamous cells of undetermined significance and one patient had an SIL.

CONCLUSIONS

The incidence of AGUS among postmenopausal patients was similar to that of the general population (0.51% vs. 0.56%; P > 0.05). A significant percentage of these patients were found to have a clinically significant lesion on subsequent follow-up. Furthermore, a majority of these lesions were ACA (53%) or HGSIL (26%). The findings of the current study strongly suggest the need for the close follow-up of postmenopausal patients with a diagnosis of AGUS. Cancer (Cancer Cytopathol)

摘要

背景

绝经后女性巴氏涂片出现腺细胞异型性很常见。这一发现可能是干燥假象和炎症改变等人为改变的结果，也可能代表鳞状或腺性的癌前或肿瘤性病变。因此，确定绝经后患者意义不明确的非典型腺细胞（AGUS）诊断的临床意义很重要。

方法

1995年至1997年间共收集了30036例绝经后女性的巴氏涂片。其中，154例（0.51%）诊断为AGUS。133例患者（86.4%）有随访资料；110例患者（82.7%）有组织学随访（包括宫颈活检、宫颈管刮除术和/或子宫内膜活检），23例患者（17.3%）进行了重复涂片检查。

结果

110例患者中有36例（32.7%）在后续组织学随访中发现有临床意义的病变（定义为癌前或肿瘤性、腺性或鳞状病变）。19例患者（53%）有腺性病变（15例子宫内膜腺癌[ACA]、2例宫颈管ACA、1例宫颈管原位腺癌和1例子宫内膜增生）。17例患者（47%）有鳞状上皮内病变（SIL）（6例低级别SIL、9例高级别[SIL]和2例鳞状细胞癌）。在进行重复巴氏涂片检查的患者中，5例患者持续存在AGUS/意义不明确的非典型鳞状细胞，1例患者有SIL。