Krane J F, Granter S R, Trask C E, Hogan C L, Lee K R
Division of Cytology, Department of Pathology, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Cancer. 2001 Feb 25;93(1):8-15.
Papanicolaou smear sensitivity for cervical adenocarcinoma (CVCA) is not well established. Also uncertain are the relative contributions to falsely negative diagnoses of sampling, screening, and interpretive errors.
Papanicolaou smears were identified from all patients at our institutions with biopsy-proven cervical adenocarcinoma from 1988-1998. All available negative and unsatisfactory smears were reviewed.
Of 49 patients with CVCA, 66 smears initially diagnosed as negative and 4 smears initially diagnosed as unsatisfactory from 30 patients were identified. Thirty-two negative smears and 4 unsatisfactory smears from 19 patients were available for review. The retrospective diagnoses in the cases initially called negative were: unsatisfactory in 2, negative in 15, and atypical glandular cells consistent with either adenocarcinoma in situ (AIS) or CVCA in 15. Three of four smears initially called unsatisfactory had neoplastic glandular cells identified retrospectively. The 18 falsely negative or falsely unsatisfactory smears were from 13 patients obtained up to 5 years before biopsy diagnosis. These smears contained neoplastic cells likely to have been mistaken for lower segment endometrial cells (LUS) or endocervical cells with tubal metaplasia (TM) in 11, reactive endocervical cells in 6, and both in 1. In 16 of the 18 smears, the abnormal cells were abundant, although preservation was suboptimal in 6.
Sensitivity of a single Papanicolaou smear for CVCA was between 45% and 76% depending on the classification of negative slides that were not available for review, comparable to previously reported sensitivity for AIS. The diagnostic false-negative or false-unsatisfactory rate in reviewed smears was 50% (18 of 36). Diminished sensitivity is due to the under recognition of glandular neoplasia resembling LUS, TM, or reactive endocervical cells. Cancer (Cancer Cytopathol)
巴氏涂片对宫颈腺癌（CVCA）的敏感性尚未明确确立。采样、筛查和解读错误对假阴性诊断的相对贡献也不确定。
从1988年至1998年在我们机构经活检证实为宫颈腺癌的所有患者中识别巴氏涂片。对所有可用的阴性和不满意涂片进行复查。
在49例CVCA患者中，从30例患者中识别出66份最初诊断为阴性的涂片和4份最初诊断为不满意的涂片。来自19例患者的32份阴性涂片和4份不满意涂片可供复查。最初诊断为阴性的病例的回顾性诊断结果为：2份不满意，15份阴性，15份非典型腺细胞符合原位腺癌（AIS）或CVCA。最初诊断为不满意的4份涂片中，有3份经回顾性检查发现有肿瘤性腺细胞。这18份假阴性或假不满意涂片来自活检诊断前长达5年的13例患者。这些涂片中的肿瘤细胞在11例中可能被误认为是下段子宫内膜细胞（LUS）或伴有输卵管化生（TM）的宫颈内膜细胞，6例中为反应性宫颈内膜细胞，1例中两者皆有。在18份涂片中的16份中，异常细胞丰富，尽管6份涂片的保存情况欠佳。
根据无法复查的阴性玻片的分类，单次巴氏涂片对CVCA的敏感性在45%至76%之间，与先前报道的AIS敏感性相当。复查涂片中的诊断假阴性或假不满意率为50%（36份中的18份）。敏感性降低是由于对类似LUS、TM或反应性宫颈内膜细胞的腺性肿瘤识别不足。癌症（癌症细胞病理学）
