Friedlander Maria A, Stier Elizabeth, Lin Oscar
Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Cancer. 2004 Feb 25;102(1):19-26. doi: 10.1002/cncr.11888.
Anorectal cytology has been increasingly used as a screening method for anal squamous lesions, particularly in high-risk, homosexual, patients with human immunodeficiency virus infection. The diagnostic cytologic, anoscopic, and histologic criteria bear some resemblance to the criteria used in cervicovaginal samples with few differences. It is important to recognize these differences because they can lead to an erroneous diagnosis of dysplasia and unnecessary procedures.
Seventy-eight anorectal cytology specimens from 51 patients were reviewed blindly. Of the 51 patients, 33 were HIV positive. The cytology specimens consisted of 75 ThinPrep (Cytyc, Boxborough, MA) and 3 conventional Papanicolaou-stained smear specimens. The revised diagnosis was compared with the original diagnosis, corresponding histology specimens, and anoscopic results, when available.
Six specimens were unsatisfactory for review. The revised diagnosis was negative in 15 patients, atypical squamous cells of undetermined significance in 3 patients, low-grade squamous intraepithelial lesions in 24 patients, high-grade squamous intraepithelial lesions in 28 patients, and squamous cell carcinoma (SQC) in 2 patients. Five patients with an original diagnosis of SQC had the diagnosis revised upon review of their specimens. It is noteworthy that these five specimens showed the presence of atypical parakeratotic cells. Thirty-two patients had anoscopic evaluation and 30 patients had histologic correlation. Twenty-seven patients with abnormal anoscopic findings had confirmed abnormal histologic findings. Twenty- five of the 32 (78%) patients had abnormal cytology that correlated with abnormal anoscopic findings.
Anorectal cytology is an accurate method for screening patients for anal squamous lesions. Atypical parakeratotic cells represent a potential pitfall. Anoscopy is important in confirming the presence of a lesion, but only a biopsy can accurately determine the grade of a lesion.
肛门直肠细胞学检查越来越多地被用作肛门鳞状病变的筛查方法，尤其是在高危的、感染人类免疫缺陷病毒的同性恋患者中。诊断性细胞学、肛门镜检查和组织学标准与宫颈阴道样本中使用的标准有一些相似之处，但差异不大。认识到这些差异很重要，因为它们可能导致发育异常的错误诊断和不必要的手术。
对来自51例患者的78份肛门直肠细胞学标本进行了盲法回顾。在这51例患者中，33例为HIV阳性。细胞学标本包括75份ThinPrep（Cytyc公司，马萨诸塞州博克斯伯勒）和3份传统巴氏染色涂片标本。将修订后的诊断与原始诊断、相应的组织学标本以及可用时的肛门镜检查结果进行比较。
6份标本因无法进行回顾而不合格。修订后的诊断为15例患者为阴性，3例患者为意义不明确的非典型鳞状细胞，24例患者为低级别鳞状上皮内病变，28例患者为高级别鳞状上皮内病变，2例患者为鳞状细胞癌（SQC）。5例最初诊断为SQC的患者在复查标本后诊断被修订。值得注意的是，这5份标本显示存在非典型不全角化细胞。32例患者进行了肛门镜检查，30例患者有组织学相关性。27例肛门镜检查结果异常的患者经组织学检查证实异常。32例患者中有25例（78%）细胞学异常与肛门镜检查结果异常相关。
肛门直肠细胞学检查是筛查肛门鳞状病变患者的准确方法。非典型不全角化细胞是一个潜在的陷阱。肛门镜检查对于确认病变的存在很重要，但只有活检才能准确确定病变的级别。
