Pity Intisar S, Shamdeen Maida Y, Wais Shawnim A
Department of Pathology, Faculty of Medicine, University of Duhok, Duhok, Iraq.
Asian Pac J Cancer Prev. 2012;13(7):3455-60. doi: 10.7314/apjcp.2012.13.7.3455.
To report the prevalence of atypical squamous cells of undetermined significance and atypical squamous cells-cannot exclude high squamous intraepithelial lesion and to determine the possible association of Pap test results with high-risk human papillomavirus and high squamous intraepithelial lesions in women from Duhok, Iraq.
A prospective, observational study was conducted between January 2005 and December 2011. Overall, 596 women with a cervicovaginal Pap test showing atypical squamous cells of undetermined significance and 93 atypical squamous cells-cannot exclude high squamous intraepithelial lesion for whom pathologic follow-up was available were studied. Follow-up consisted of repeat cytology, colposcopy and histology. High risk human papillomavirus DNA testing was performed on exfoliated cervical cells from 106 women, using conventional PCR after at least 36 months from the initial Pap smear.
Significantly high proportions of both atypical squamous cells of undetermined significance (87.9%) and atypical squamous cells-cannot exclude high squamous intraepithelial lesion (62.4%) demonstrated no significant lesion on subsequent follow up. Low squamous intraepithelial lesions were observed in 1.7% of cases of atypical squamous cells of undetermined significance and in 5.4% of atypical squamous cells-cannot exclude high squamous intraepithelial lesion. High squamous intraepithelial lesion was demonstrated in 0.8% and 16.1% respectively. In the latter there was also one case of invasive carcinoma. High-risk HPV DNA was demonstrated in 40% of atypical squamous cells of undetermined significance and 57.1% of atypical squamous cells-cannot exclude high squamous intraepithelial lesions.
Since both atypical squamous cells of undetermined significance and atypical squamous cells-cannot exclude high squamous intraepithelial lesion identify patients who are at an increased risk for the development of high squamous intraepithelial lesions and a considerable percentage harbor high risk-HPV, both should be retained as diagnostic categories and patients warrant a diligent follow up and testing for high risk-HPV DNA. Colposcopic evaluation and biopsy, when indicated, are a must.
报告意义不明确的非典型鳞状细胞及不能排除高级别鳞状上皮内病变的非典型鳞状细胞的患病率，并确定伊拉克杜胡克地区女性巴氏试验结果与高危型人乳头瘤病毒及高级别鳞状上皮内病变之间的可能关联。
于2005年1月至2011年12月进行了一项前瞻性观察性研究。共研究了596例宫颈阴道巴氏试验显示意义不明确的非典型鳞状细胞的女性以及93例有病理随访结果的不能排除高级别鳞状上皮内病变的非典型鳞状细胞女性。随访包括重复细胞学检查、阴道镜检查和组织学检查。在初次巴氏涂片至少36个月后，对106名女性的脱落宫颈细胞进行常规聚合酶链反应高危型人乳头瘤病毒DNA检测。
意义不明确的非典型鳞状细胞（87.9%）和不能排除高级别鳞状上皮内病变的非典型鳞状细胞（62.4%）中，有相当高比例在后续随访中未发现明显病变。意义不明确的非典型鳞状细胞病例中有1.7%观察到低级别鳞状上皮内病变，不能排除高级别鳞状上皮内病变的非典型鳞状细胞病例中有5.4%观察到该病变。高级别鳞状上皮内病变分别为0.8%和16.1%。后者中还有1例浸润癌。高危型人乳头瘤病毒DNA在40%的意义不明确的非典型鳞状细胞和57.1%的不能排除高级别鳞状上皮内病变的非典型鳞状细胞中被检测到。
由于意义不明确的非典型鳞状细胞和不能排除高级别鳞状上皮内病变的非典型鳞状细胞均表明患者发生高级别鳞状上皮内病变的风险增加，且相当比例携带高危型人乳头瘤病毒，因此这两种情况均应保留为诊断类别，患者需要进行认真的随访和高危型人乳头瘤病毒DNA检测。必要时必须进行阴道镜评估和活检。
