Schoolland Meike, Segal Amanda, Allpress Stephen, Miranda Alina, Frost Felicity A, Sterrett Gregory F
Department of Cytopathology, Western Diagnostic Pathology, Myaree, Western Australia, Australia.
Cancer. 2002 Dec 25;96(6):330-7. doi: 10.1002/cncr.10886.
The current study examines 1) the sensitivity of detection and 2) sampling and screening/diagnostic error in the cytologic diagnosis of adenocarcinoma in situ (AIS) of the cervix. The data were taken from public and private sector screening laboratories reporting 25,000 and 80,000 smears, respectively, each year.
The study group was comprised of women with a biopsy diagnosis of AIS or AIS combined with a high-grade squamous intraepithelial lesion (HSIL) who were accessioned by the Western Australian Cervical Cytology Registry (WACCR) between 1993-1998. Cervical smears reported by the Western Australia Centre for Pathology and Medical Research (PathCentre) or Western Diagnostic Pathology (WDP) in the 36 months before the index biopsy was obtained were retrieved. A true measure of the sensitivity of detection could not be determined because to the authors' knowledge the exact prevalence of disease is unknown at present. For the current study, sensitivity was defined as the percentage of smears reported as demonstrating a possible or definite high-grade epithelial abnormality (HGEA), either glandular or squamous. Sampling error was defined as the percentage of smears found to have no HGEA on review. Screening/diagnostic error was defined as the percentage of smears in which HGEA was not diagnosed initially but review demonstrated possible or definite HGEA. Sensitivity also was calculated for a randomly selected control group of biopsy proven cases of Grade 3 cervical intraepithelial neoplasia (CIN 3) accessioned at the WACCR in 1999.
For biopsy findings of AIS alone, the diagnostic "sensitivity" of a single smear was 47.6% for the PathCentre and 54.3% for WDP. Nearly all the abnormalities were reported as glandular. The sampling and screening/diagnostic errors were 47.6% and 4.8%, respectively, for the PathCentre and 33.3% and 12.3%, respectively, for WDP. The results from the PathCentre were better for AIS plus HSIL than for AIS alone, but the results from WDP were similar for both groups. For the CIN 3 control cases, the "sensitivity" of a single smear was 42.5%.
To the authors' knowledge epidemiologic studies published to date have not demonstrated a benefit from screening for precursors of cervical adenocarcinoma. However, in the study laboratories as in many others, reasonable expertise in diagnosing AIS has been acquired only within the last 10-15 years, which may be too short a period in which to demonstrate a significant effect. The results of the current study provide some encouraging baseline data regarding the sensitivity of the Papanicolaou smear in detecting AIS. Further improvements in sampling and cytodiagnosis may be possible.
本研究调查了1）宫颈原位腺癌（AIS）细胞学诊断中的检测敏感性，以及2）采样和筛查/诊断误差。数据分别取自每年报告25,000份和80,000份涂片的公共和私营部门筛查实验室。
研究组由1993年至1998年间被西澳大利亚宫颈细胞学登记处（WACCR）收录的活检诊断为AIS或AIS合并高级别鳞状上皮内病变（HSIL）的女性组成。检索了西澳大利亚病理与医学研究中心（PathCentre）或西诊断病理学（WDP）在索引活检前36个月报告的宫颈涂片。由于据作者所知目前疾病的确切患病率未知，因此无法确定检测敏感性的真实测量值。在本研究中，敏感性定义为报告显示可能或确定的高级别上皮异常（HGEA）（腺性或鳞状）的涂片百分比。采样误差定义为复查时发现无HGEA的涂片百分比。筛查/诊断误差定义为最初未诊断出HGEA但复查显示可能或确定HGEA的涂片百分比。还计算了1999年在WACCR登记的活检证实为3级宫颈上皮内瘤变（CIN 3）的随机选择对照组的敏感性。
对于仅为AIS的活检结果，PathCentre的单次涂片诊断“敏感性”为47.6%，WDP为54.3%。几乎所有异常均报告为腺性。PathCentre的采样和筛查/诊断误差分别为47.6%和4.8%，WDP分别为33.3%和12.3%。PathCentre对于AIS加HSIL的结果比对单独AIS的结果更好，但WDP两组的结果相似。对于CIN 3对照病例，单次涂片的“敏感性”为42.5%。
据作者所知，迄今为止发表的流行病学研究尚未证明筛查宫颈腺癌前体有好处。然而，在本研究实验室以及许多其他实验室中，仅在过去10至15年内才获得了诊断AIS的合理专业知识，这可能是一个太短的时间段，不足以证明有显著效果。本研究结果提供了一些关于巴氏涂片检测AIS敏感性的令人鼓舞的基线数据。采样和细胞诊断可能会有进一步改进。
