Chummun K, Fitzpatrick M, Lenehan P, Boylan P, Mooney E, Flannelly G
National Maternity Hospital, Dublin, Ireland.
Cytopathology. 2012 Dec;23(6):378-82. doi: 10.1111/j.1365-2303.2012.00981.x. Epub 2012 May 14.
In 2008, the management of women in Ireland with atypical glandular cells changed to immediate referral to colposcopy. The optimal management of these women is unclear. A balance between the detection of occult disease and overtreatment is required.
Our study aim was to document the experience of this policy at the National Maternity Hospital, Dublin. Information from the computerized data management system was analysed with the statistical package SPSS.
In 2009, 156 women attended colposcopy following a single atypical glandular cell diagnosis on liquid-based cytology. The mean age was 41 years. Thirty (19.2%) women had abnormal vaginal bleeding, 31 (19.9%) were smokers and 34 (21.8%) had received previous treatment. The colposcopy was satisfactory in 125 (80.1%) and unsatisfactory in 31 (19.9%). Cervical histology was available for 146 (93.6%) women: 57 excisional procedures and 89 diagnostic biopsies. Abnormal histology was detected in 46 women (31.5%). Four women (2.7%) had invasive cancer, five (3.4%) had adenocarcinoma in situ, 21 (14.4%) had cervical intraepithelial neoplasia (CIN) grade 2 or 3 and 16 (11.0%) had CIN1. No abnormality was detected in 100 women (68.5%), including 35 (61.4%) of those who had undergone excisional procedures. The colposcopic impression in this group was unsatisfactory in 10 women (28.6%), glandular abnormalities in six (17.1%), high- and low-grade changes in 12 (34.2%) and six (17.1%) women, respectively, and normal in one (2.9%). The findings were essentially negative in the remaining 10 women: overall, 30 (19.2%) of the 156 women referred to colposcopy had at least CIN2.
This study confirmed significant levels of high-grade disease in women referred to colposcopy with atypical glandular cells on cytology. Concerns about undetected endocervical disease resulted in high levels of negative excisional biopsies. Alternative strategies, including endometrial sampling, human papillomavirus testing and discussion at clinicopathological meeting, should be considered.
2008年，爱尔兰对非典型腺细胞女性的管理方式转变为立即转诊至阴道镜检查。这些女性的最佳管理方式尚不清楚。需要在隐匿性疾病的检测和过度治疗之间取得平衡。
我们的研究目的是记录都柏林国家妇产医院这一政策的实施经验。利用统计软件SPSS分析来自计算机化数据管理系统的信息。
2009年，156名女性在液基细胞学检查诊断出非典型腺细胞后接受了阴道镜检查。平均年龄为41岁。30名（19.2%）女性有异常阴道出血，31名（19.9%）为吸烟者，34名（21.8%）曾接受过治疗。125名（80.1%）女性的阴道镜检查结果满意，31名（19.9%）不满意。146名（93.6%）女性有宫颈组织学检查结果：57例为切除手术，89例为诊断性活检。46名女性（31.5%）检测到异常组织学结果。4名女性（2.7%）患有浸润癌，5名（3.4%）患有原位腺癌，21名（14.4%）患有宫颈上皮内瘤变（CIN）2级或3级，16名（11.0%）患有CIN1。100名女性（68.5%）未检测到异常，其中包括35名（61.4%）接受切除手术的女性。该组中阴道镜检查印象不满意的有10名女性（28.6%），腺性异常的有6名（17.1%），高级别和低级别改变的分别有12名（34.2%）和6名（17.1%）女性，正常的有1名（2.9%）。其余10名女性的检查结果基本为阴性：总体而言，156名转诊至阴道镜检查的女性中有30名（19.2%）至少患有CIN2。
本研究证实，细胞学检查有非典型腺细胞而转诊至阴道镜检查的女性中，高级别疾病的比例较高。对未检测到的宫颈管疾病的担忧导致了大量阴性切除活检。应考虑其他策略，包括子宫内膜取样、人乳头瘤病毒检测以及在临床病理会议上进行讨论。
