Tam K F, Cheung A N Y, Liu K L, Ng T Y, Pun T C, Chan Y M, Wong L C, Ng A W Y, Ngan H Y S
Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong.
Gynecol Oncol. 2003 Dec;91(3):603-7. doi: 10.1016/j.ygyno.2003.08.029.
The Bethesda system for reporting cervicovaginal cytologic diagnoses was recently revised in 2001. Pathologists are required to report not only whether the smear favors neoplastic changes, but also the origin of the abnormal cells. In this study, archival smears were reviewed to evaluate the usefulness of the new classification.
Smears having atypical glandular cells taken between January 1995 and December 1997 were reviewed and subclassified according to the revised Bethesda classification. Case records were then reviewed and cases with discrepancies between the cytological evaluation and corresponding final histological diagnoses were further reviewed.
There were 138 smears reviewed. The mean age of the patients was 47 (range, 18 to 78). Thirty-four smears favored neoplasia and 104 favored "NOS" ("not otherwise specified"). Sixty smears favored endocervical origin and 78 endometrial origin. Forty-three patients (31%) had significant pathologies, including 12 (8.7%) patients with high-grade CIN, 2 (1.4%) with low-grade CIN, 5 (3.6%) with HPV infection, 7 (5.1%) with carcinoma of the corpus, 1 (0.7%) with cervical adenocarcinoma in situ, 4 (2.9%) with adenocarcinoma of the cervix, 3 (2.2%) with endometrial hyperplasia, and 5 (3.6%) with carcinoma of the ovary. Two (1.4%) patients had double primary female genital malignancies and 2 patients (1.4%) had extragenital malignancies. Significant correlation was found between smears "favor neoplasia" and a final diagnosis with significant pathology (chi(2) test, P < 0.05). Significant association was found between AGC favored endocervical origin and a final diagnosis with cervical diseases (chi(2) test, P < 0.05). Four of the 43 patients who had significant pathologies had lesions found during their subsequent visits and all of them had cervical smears classified as AGC "favor neoplasia".
AGC found on cervical smears are an indication for early and intensive investigation.
贝塞斯达系统用于报告宫颈阴道细胞学诊断，该系统最近于2001年进行了修订。要求病理学家不仅要报告涂片是否提示肿瘤性改变，还要报告异常细胞的来源。在本研究中，回顾存档涂片以评估新分类的实用性。
回顾1995年1月至1997年12月间采集的具有非典型腺细胞的涂片，并根据修订后的贝塞斯达分类进行亚分类。然后查阅病例记录，对细胞学评估与相应最终组织学诊断存在差异的病例进行进一步审查。
共回顾了138张涂片。患者的平均年龄为47岁（范围18至78岁）。34张涂片提示肿瘤，104张提示“未另行指定”（NOS）。60张涂片提示宫颈管来源，78张提示子宫内膜来源。43例患者（31%）有显著病变，包括12例（8.7%）高级别CIN患者、2例（1.4%）低级别CIN患者、5例（3.6%）HPV感染患者、7例（5.1%）子宫内膜癌患者、1例（0.7%）宫颈原位腺癌患者、4例（2.9%）宫颈腺癌患者、3例（2.2%）子宫内膜增生患者和5例（3.6%）卵巢癌患者。2例（1.4%）患者有双原发性女性生殖系统恶性肿瘤，2例（1.4%）患者有生殖器外恶性肿瘤。在涂片“提示肿瘤”与最终诊断为显著病变之间发现显著相关性（卡方检验，P<0.05）。在提示宫颈管来源的非典型腺细胞（AGC）与最终诊断为宫颈疾病之间发现显著关联（卡方检验，P<0.05）。43例有显著病变的患者中有4例在随后的随访中发现病变，且所有患者的宫颈涂片均分类为AGC“提示肿瘤”。
宫颈涂片上发现的AGC是早期和深入检查的指征。
