Nassar Aziza, Fleisher Seth R, Nasuti Joseph F
Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Road, N.E., Room H-174, Atlanta, Georgia 30324, USA.
Acta Cytol. 2003 Sep-Oct;47(5):762-7. doi: 10.1159/000326602.
To determine the clinical implications of the finding of histiocytes in Pap smears in 1 patient population.
The medical records and Pap smears which the presence of histiocytes was mentioned in the diagnosis between August 1996 and August 2001 were reviewed in conjunction with follow-up surgical findings. The positive predictive value (PPV) for significant endometrial pathology for the isolated finding of histiocytes on Pap smear was determined.
Of the 238,225 women screened over a 60-month period, 325 were reported to have histiocytes in their Pap smears. Of them, 238 (73.2%) had subsequent endometrial sampling, hysterectomy or both, and follow-up Pap smears. Two hundred seven smears (87%) failed to disclose endometrial pathology. Thirty-one cases (13%) resulted in significant histopathologic findings, including 12 uterine malignancies, 8 endocervical polyps, 7 endometrial polyps, 2 submucosal leiomyomata, 1 simple hyperplasia without atypia and 1 case of tamoxifen-related changes. Upon review of the clinical records, 58% (18/31) of those patients had other significant clinical and/or cytologic findings. Five of the 18 patients (27.8%) had associated postmenopausal bleeding, 11 had additional abnormal Pap smear findings (atypical glandular cells, 6/18, or 33.3%; endometrial cells, 5/18, or 27.8%), and another 2 had both postmenopausal bleeding and atypical glandular cells (2/18, or 11.1%). The PPV for significant uterine pathology for women with the isolated finding of histiocytes on a Pap smear was 5.5% and 60% with additional clinical and/or Pap smear findings. The PPV for endometrial cancer was 1.3% in women with the isolated finding of histiocytes on a Pap smear but 20% for women with histiocytes and additional clinical/or Pap smear findings.
Based on the findings of this study and recently published data, we conclude that the isolated finding of increased histiocytes in the absence of postmenopausal bleeding, endometrial cells or atypical glandular cells on a Pap smear is a poor indicator of uterine disease.
确定在一组患者人群中，巴氏涂片检查发现组织细胞的临床意义。
回顾1996年8月至2001年8月期间诊断中提及存在组织细胞的病历和巴氏涂片，并结合后续手术结果进行分析。确定巴氏涂片单独发现组织细胞时，对显著子宫内膜病变的阳性预测值（PPV）。
在60个月期间接受筛查的238,225名女性中，有325名报告巴氏涂片中存在组织细胞。其中，238名（73.2%）随后进行了子宫内膜取样、子宫切除术或两者皆做，并进行了后续巴氏涂片检查。207份涂片（87%）未发现子宫内膜病变。31例（13%）出现显著组织病理学发现，包括12例子宫恶性肿瘤、8例宫颈息肉、7例子宫内膜息肉、2例黏膜下平滑肌瘤、1例无异型性的单纯增生以及1例与他莫昔芬相关的改变。经查阅临床记录，这些患者中有58%（18/31）有其他显著的临床和/或细胞学发现。18例患者中有5例（27.8%）伴有绝经后出血，11例有额外的巴氏涂片异常发现（非典型腺细胞，6/18，即33.3%；子宫内膜细胞，5/18，即27.8%），另外2例既有绝经后出血又有非典型腺细胞（2/18，即11.1%）。巴氏涂片单独发现组织细胞的女性，子宫病变显著的PPV为5.5%，有额外临床和/或巴氏涂片发现时为60%。巴氏涂片单独发现组织细胞的女性，子宫内膜癌的PPV为1.3%，但有组织细胞且有额外临床/或巴氏涂片发现的女性为20%。
基于本研究结果及近期发表的数据，我们得出结论，巴氏涂片在无绝经后出血、子宫内膜细胞或非典型腺细胞情况下单独发现组织细胞增多，对子宫疾病的指示性较差。
