Johnston Elizabeth I, Logani Sanjay
Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA 30322, USA.
Cancer. 2007 Jun 25;111(3):160-5. doi: 10.1002/cncr.22687.
The authors have noted that in cervical cytology specimens from perimenopausal and postmenopausal women, the diagnosis of atypical squamous cells of undetermined significance (ASC-US), as defined in the Bethesda system, is often not associated with a clinically evident lesion on follow-up. Reflex human papillomavirus (HPV) testing provides an opportunity to distinguish cytologic features of significance from those within the spectrum of benign cellular change in this age group.
Liquid-based preparations that were diagnosed as ASC-US between January 2003 and July 2005 at Emory University Hospital were identified from the computer files. The results of HPV-DNA testing were recorded. Two hundred four Papanicolaou tests from perimenopausal women (n = 81, 40-49 years) and postmenopausal women (n = 123, >50 years) were reviewed in a blinded fashion.
HPV-DNA results were available for 903 of 1044 patients diagnosed as ASC-US. Overall, 323 results (35.8%) were positive, 510 results (56.6%) were negative, and 70 results (7.8%) were indeterminate. In addition, 73% of ASC-US specimens in patients aged > or =40 years were negative for HPV DNA. The HPV-DNA detection rate dropped from 60% in the group ages 10 to 19 years to approximately 18% in the group aged >50 years. A review of HPV-negative cases in the group aged >40 years showed squamous cells with random nuclear enlargement and slight hyperchromasia that likely were interpreted as ASC-US (based on the cells that were dotted by the original reviewer). Nuclear grooves were frequent in these nuclei; and cytoplasmic halos, when present, usually were perinuclear.
HPV-DNA detection in cervical cytology specimens has an inverse relation to patient age. A diagnosis of ASC-US in perimenopausal and postmenopausal women is likely to result in a negative HPV-DNA test in a significant proportion of patients. Enlarged nuclei with nuclear grooves and slight hyperchromasia are possibly the cause of ASC-US overdiagnosis in this age group.
作者注意到，在围绝经期和绝经后妇女的宫颈细胞学标本中，按照贝塞斯达系统定义的意义不明确的非典型鳞状细胞（ASC-US）诊断，在后续随访中往往与临床上明显的病变无关。反射性人乳头瘤病毒（HPV）检测为区分该年龄组中有意义的细胞学特征与良性细胞变化范围内的特征提供了机会。
从计算机文件中识别出2003年1月至2005年7月在埃默里大学医院被诊断为ASC-US的液基制片。记录HPV-DNA检测结果。以盲法回顾了204例围绝经期妇女（n = 81，40 - 49岁）和绝经后妇女（n = 123，>50岁）的巴氏试验。
1044例被诊断为ASC-US的患者中有903例获得了HPV-DNA结果。总体而言，323例结果（35.8%）为阳性，510例结果（56.6%）为阴性，70例结果（7.8%）不确定。此外，年龄≥40岁患者的ASC-US标本中73%的HPV DNA检测为阴性。HPV-DNA检测率从10至19岁年龄组的60%降至>50岁年龄组的约18%。对年龄>40岁组HPV阴性病例的回顾显示，鳞状细胞有随机核增大和轻度核染色质增多，可能被解释为ASC-US（基于最初阅片者标记的细胞）。这些细胞核中核沟常见；存在胞质晕时，通常为核周性。
宫颈细胞学标本中HPV-DNA检测与患者年龄呈负相关。围绝经期和绝经后妇女的ASC-US诊断在很大比例的患者中可能导致HPV-DNA检测阴性。核增大伴核沟和轻度核染色质增多可能是该年龄组ASC-US过度诊断的原因。
