口服避孕药与液基薄层制片巴氏涂片检查中出现的类似低度鳞状上皮内病变的假象有关。

Oral contraceptive pills are associated with artifacts in ThinPrep Pap smears that mimic low-grade squamous intraepithelial lesions.

作者信息

Morrison Carl, Prokorym Patricia, Piquero Clara, Wakely Paul E, Nuovo Gerard J

机构信息

Department of Pathology, The Ohio State University Medical Center, Columbus, Ohio 43210, USA.

出版信息

Cancer. 2003 Apr 25;99(2):75-82. doi: 10.1002/cncr.11056.

DOI:10.1002/cncr.11056

PMID:12704686

Abstract

BACKGROUND

The authors noted a significant increase in the diagnosis of atypical squamous cells of undetermined significance (ASCUS) in premenopausal women using oral contraceptive pills (OCP) (9%) versus women not on OCP (4%) using ThinPrep Pap smears (P = 0.02). The purpose of this study was to correlate these morphologic changes with human papillomavirus (HPV) DNA detection by in situ hybridization and clinical follow-up.

METHODS

Eighty-four ThinPrep Pap smears diagnosed as ASCUS or ASCUS favor low-grade squamous intraepithelial lesions (LGSIL) in young women receiving OCP were studied by HPV in situ hybridization. This information was correlated with colposcopic follow-up and AutoCyte Pap smear results. The authors also studied 80 ThinPreps from young women with a Pap smear diagnosis of unequivocal LGSIL where there was a corresponding biopsy (positive controls) and 40 ThinPreps diagnosed as within normal limits and that rescreened as such (negative controls).

RESULTS

The detection rate of HPV DNA by in situ hybridization was 33% (28 of 84) in ASCUS cases versus 90% (72 of 80) for cases of unequivocal LGSIL. A blinded review of the 29 ASCUS Pap smears performed by AutoCyte showed that 66% (19 of 29) were diagnosed as within normal limits. The majority of the cervical biopsies in the women with ASCUS by ThinPrep Pap smears were negative for dysplasia (29 of 39 [74%]) whereas 71 of 80 biopsies (88%) showed dysplasia in women with Pap smears diagnosed as unequivocal LGSIL. The periodic acid-Schiff (PAS) stain demonstrated that many of the cells with halos in the ThinPrep Pap smears that mimicked LGSIL contained glycogen.

CONCLUSION

The ThinPrep induces changes that mimic LGSIL in young women on OCP. These artifacts may reflect pressure-induced alteration of glycogen. PAS analysis and, more directly, HPV testing by in situ hybridization can help differentiate this mimicking from actual LGSILs.

摘要

背景

作者注意到，使用薄层液基细胞学检测（ThinPrep Pap）时，服用口服避孕药（OCP）的绝经前女性非典型鳞状细胞意义不明确（ASCUS）的诊断率显著高于未服用OCP的女性（分别为9%和4%，P = 0.02）。本研究旨在通过原位杂交检测人乳头瘤病毒（HPV）DNA，并进行临床随访，将这些形态学变化与之关联。

方法

对84例服用OCP的年轻女性的薄层液基细胞学涂片诊断为ASCUS或倾向于低级别鳞状上皮内病变（LGSIL）的样本进行HPV原位杂交研究。将该信息与阴道镜随访结果和自动细胞涂片结果相关联。作者还研究了80例年轻女性的薄层液基细胞学涂片，这些涂片诊断为明确的LGSIL，并进行了相应活检（阳性对照），以及40例诊断为正常范围且再次筛查结果相同的薄层液基细胞学涂片（阴性对照）。

结果

原位杂交检测HPV DNA的阳性率在ASCUS病例中为33%（84例中的28例），而在明确的LGSIL病例中为90%（80例中的72例）。对自动细胞涂片进行的29例ASCUS涂片的盲法复查显示，66%（29例中的19例）被诊断为正常范围。薄层液基细胞学涂片诊断为ASCUS的女性中，大多数宫颈活检结果为发育异常阴性（39例中的29例[74%]），而在诊断为明确LGSIL的女性中，80例活检中有71例（88%）显示发育异常。过碘酸希夫（PAS）染色显示，薄层液基细胞学涂片中许多有晕圈的类似LGSIL的细胞含有糖原。