Slama J, Freitag P, Dundr P, Duskova J, Fischerova D, Zikan M, Pinkavova I, Cibula D
Department of Oncogynecology, General Teaching Hospital and 1st Medical School of Charles University, 12 800 Prague 2, Czech Republic.
Cytopathology. 2012 Dec;23(6):383-8. doi: 10.1111/j.1365-2303.2011.00898.x. Epub 2011 Aug 17.
The incidence of cervical cancers increases with age. Due to the trend of increasing age of first pregnancy, abnormal Pap smears including those classified as atypical glandular cells (AGC) are being found more often in early pregnancy. Once invasive cancer is excluded, conservative management of squamous intraepithelial lesions (SIL) in pregnancy is considered safe; however, optimal management of AGC is not well established. The aim of our study was to evaluate the outcome of patients with AGC diagnosed from smears during pregnancy.
The study included 17 patients referred to us in early pregnancy with Pap smears reported as AGC: 11 not otherwise specified (AGC-NOS), five favour neoplasia (AGC-FN) and one adenocarcinoma in situ (AIS). Thirty-one with high-grade SIL (HSIL) Pap smears confirmed on punch biopsy in early pregnancy comprised a control group. Human papillomavirus (HPV) positivity was found in seven patients with persistent AGC-NOS (including all four who had CIN3 postpartum). All the women were initially examined by expert colposcopy and those with AGC-FN or AIS smears also by transrectal ultrasound to exclude invasive endocervical cancer. Follow-up controls were carried out every 8-12 weeks and, if there were no signs of progression, revaluation was scheduled 6-8 weeks after delivery.
The mean age of the women was 31.4 years. Conization in one patient in the study group was performed in the 16th week of pregnancy due to colposcopic signs of microinvasive squamous cell cancer confirmed on histology. Progression to invasive cancer was not found in any of the other 16 patients in the study group or in the control group. Cervical intraepithelial neoplasia or AIS was confirmed postpartum by conization or punch biopsy in 47.1% (8/17) of patients in the study group and, in 77.4% (24/31) of patients in the control group.
Conservative management of women with AGC in pregnancy is safe where invasive cancer is excluded. As histological verification of glandular pre-cancerous lesions by punch biopsy is not reliable and the postpartum regression rate cannot be determined precisely, conization should be performed in all cases with AGC-FN or AIS. Triage of persistent AGC-NOS with HPV testing is useful in distinguishing significant underlying lesions.
宫颈癌的发病率随年龄增长而升高。由于初孕年龄呈上升趋势，在早孕期间发现异常巴氏涂片（包括那些分类为非典型腺细胞（AGC）的涂片）的情况越来越常见。一旦排除浸润性癌，孕期鳞状上皮内病变（SIL）的保守治疗被认为是安全的；然而，AGC的最佳治疗方法尚未完全确立。我们研究的目的是评估孕期涂片诊断为AGC的患者的结局。
该研究纳入了17例早孕时因巴氏涂片报告为AGC而转诊至我们这里的患者：11例未另行指定（AGC-NOS），5例倾向于肿瘤（AGC-FN），1例原位腺癌（AIS）。31例早孕时经活检证实为高级别SIL（HSIL）巴氏涂片的患者组成对照组。7例持续性AGC-NOS患者（包括产后患有CIN3的所有4例患者）检测到人乳头瘤病毒（HPV）阳性。所有女性最初均接受专家阴道镜检查，AGC-FN或AIS涂片的患者还接受经直肠超声检查以排除宫颈浸润癌。每8 - 12周进行一次随访检查，如果没有进展迹象，则在产后6 - 8周安排复查。
这些女性的平均年龄为31.4岁。研究组中的1例患者在妊娠第16周因组织学证实有微浸润鳞状细胞癌的阴道镜表现而进行了锥切术。研究组的其他16例患者或对照组中均未发现进展为浸润性癌的情况。研究组47.1%（8/17）的患者和对照组77.4%（24/31）的患者产后经锥切术或活检证实有宫颈上皮内瘤变或AIS。
在排除浸润性癌的情况下，孕期AGC女性的保守治疗是安全的。由于通过活检对腺性癌前病变进行组织学验证不可靠，且无法精确确定产后的消退率，因此所有AGC-FN或AIS病例均应进行锥切术。用HPV检测对持续性AGC-NOS进行分流有助于区分潜在的重要病变。
