Mariani Rachel, Grace Chelestes, Hughes Kathryn, Dietrich Ruth M, Cabay Robert J, David Odile
Department of Pathology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
Diagn Cytopathol. 2014 Mar;42(3):200-4. doi: 10.1002/dc.22991. Epub 2013 Apr 3.
The category of atypical glandular cells (AGC) in gynecologic cytopathology presents many well-documented diagnostic challenges, the most significant related to high interobserver variability, low specificity, and low positive predictive value. The current Bethesda System provides criteria for specific glandular categories including atypical endocervical cells not otherwise specified (AEC-NOS), AEC favor neoplastic, and atypical endometrial cells. The Bethesda System does, however, acknowledge that in some cases AGC cannot be categorized based upon cell of origin, in which case the generic term "atypical glandular cells" (AGC) may be used. We sought to determine whether further refinement of the current Bethesda System criteria for AEC-NOS might increase the positive predictive value of the general category of AGC. Fifty-three cases of AGC with documented histologic follow-up at the University of Illinois Hospital were reviewed. The cases were graded on each of the eight specific cytologic criteria recommended by the current Bethesda System for AEC-NOS using a study-developed three-tier grading system. Multiple regression analysis showed that four of the cytologic criteria in combination--nuclear enlargement, nuclear pleomorphism, increased nuclear-to-cytoplasmic (N/C) ratio, and cells occurring in sheets and strips with cell crowding and nuclear overlap--discriminated positive histologic outcome slightly better than any single criterion alone. In addition, simple logistic regression analysis showed nuclear enlargement to have a marginal independent association with positive histologic outcome (P = 0.0566). No other criterion was independently associated with outcome. Ancillary methods seem indicated to increase the positive predictive value of AGC at this time.
妇科细胞病理学中的非典型腺细胞（AGC）类别存在许多有充分文献记载的诊断挑战，其中最显著的与观察者间差异大、特异性低和阳性预测值低有关。当前的贝塞斯达系统提供了特定腺细胞类别的标准，包括未另行指定的非典型宫颈内膜细胞（AEC-NOS）、倾向肿瘤的AEC以及非典型子宫内膜细胞。然而，贝塞斯达系统也承认，在某些情况下，AGC无法根据细胞来源进行分类，在这种情况下，可以使用通用术语“非典型腺细胞”（AGC）。我们试图确定对当前贝塞斯达系统中AEC-NOS标准的进一步细化是否可能提高AGC总体类别的阳性预测值。回顾了伊利诺伊大学医院53例有组织学随访记录的AGC病例。使用研究开发的三级分级系统，根据当前贝塞斯达系统为AEC-NOS推荐的八项特定细胞学标准对病例进行分级。多元回归分析表明，四个细胞学标准结合使用——核增大、核多形性、核质比（N/C）增加以及细胞呈片状和条索状出现且细胞拥挤和核重叠——比任何单一标准单独使用能更好地区分阳性组织学结果。此外，简单逻辑回归分析表明核增大与阳性组织学结果有边缘性独立关联（P = 0.0566）。没有其他标准与结果独立相关。目前似乎需要辅助方法来提高AGC的阳性预测值。
