Thrall Michael, Kjeldahl Klint, Gulbahce H Evin, Pambuccian Stefan E
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Cancer. 2007 Aug 25;111(4):217-23. doi: 10.1002/cncr.22770.
In addition to the reporting of atypical glandular cells (AGC) and adenocarcinoma (ADCA), the 2001 Bethesda System requires the reporting of benign-appearing endometrial cells in women aged >40 years (BAEMC). In this study, the authors evaluated the contribution of each of these reporting categories to the sensitivity and specificity of a liquid-based Papanicolaou test for endometrial carcinoma or hyperplasia.
Over the 3-year study period, in the setting of a large, multihospital health care system, the authors analyzed the results from liquid-based Papanicolaou tests that were performed within the 6 months that preceded a histologic diagnosis of endometrial carcinoma or hyperplasia and that were reported according to the 2001 Bethesda System.
Two hundred seventy-two women had a histologic diagnosis of endometrial hyperplasia (n = 199) or malignancy (n = 73) within 6 months after a Papanicolaou test. In total, 188,594 Papanicolaou tests (91,385 from women aged >40 years) were interpreted during the study period and resulted in 3810 diagnoses of BAEMC, 326 diagnoses of AGC, and 30 diagnoses of ADCA. Only 28 of 73 women (38.4%) with endometrial carcinoma had cytologically AGC or ADCA reported on a previous Papanicolaou test. The reporting of BAEMC increased this sensitivity by only 5.5% (4 additional tests) but decreased the specificity of the Papanicolaou test for endometrial malignancy from 99.8% to 96%. For endometrial hyperplasias, the sensitivity of the Papanicolaou test was even lower (39 of 198 tests; 19.7%), but BAEMC represented the majority of endometrial-type cells reported (36 of 39 tests).
The reporting of BAEMC led to an only marginal increase in sensitivity that had to be weighed against the significant loss in specificity of the Papanicolaou test for endometrial neoplasia.
除了报告非典型腺细胞（AGC）和腺癌（ADCA）外，2001年贝塞斯达系统要求报告年龄大于40岁女性的良性子宫内膜细胞（BAEMC）。在本研究中，作者评估了这些报告类别中的每一项对液基巴氏试验检测子宫内膜癌或增生的敏感性和特异性的贡献。
在为期3年的研究期间，在一个大型多医院医疗保健系统中，作者分析了在子宫内膜癌或增生组织学诊断前6个月内进行的液基巴氏试验结果，并根据2001年贝塞斯达系统进行报告。
272名女性在巴氏试验后6个月内有子宫内膜增生（n = 199）或恶性肿瘤（n = 73）的组织学诊断。在研究期间，总共解读了188,594次巴氏试验（91,385次来自年龄大于40岁女性），结果有3810次诊断为BAEMC，326次诊断为AGC以及30次诊断为ADCA。73名子宫内膜癌女性中只有28名（38.4%）在之前的巴氏试验中有细胞学AGC或ADCA报告。BAEMC的报告仅使敏感性提高了5.5%（增加了4次检测），但使巴氏试验对子宫内膜恶性肿瘤的特异性从99.8%降至96%。对于子宫内膜增生，巴氏试验的敏感性更低（198次检测中的39次；19.7%），但BAEMC是报告的大多数子宫内膜样细胞（39次检测中的36次）。
BAEMC的报告导致敏感性仅略有增加，而这必须与巴氏试验对子宫内膜肿瘤特异性的显著降低相权衡。
