Umezawa Takashi, Umemori Miyaka, Horiguchi Ayana, Nomura Kouichi, Takahashi Hiroyuki, Yamada Kyosuke, Ochiai Kazunori, Okamoto Aikou, Ikegami Masahiro, Sawabe Motoji
Address: Department of Molecular Pathology, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan ; Department of Pathology, Jikei University Hospital, Tokyo, Japan.
Department of Pathology, Jikei University Hospital, Tokyo, Japan.
Cytojournal. 2015 Apr 29;12:8. doi: 10.4103/1742-6413.156081. eCollection 2015.
The sensitivity of Papanicolaou smears for detecting endocervical adenocarcinoma in situ (AIS) is very low. A comprehensive cytological analysis of endocervical AIS is necessary to increase diagnostic accuracy.
The subjects were 74 patients with pathologically-diagnosed AIS. A total of 140 Papanicolaou smears were reviewed to calculate the sensitivity of the Papanicolaou smears for detecting AIS and the incidence of sampling/screening/diagnostic errors. The cytological review was performed by 6 cytotechnologists, and the final cytological diagnosis was obtained at the consensus meeting. We classified the cases into three differentiation types; typical type (well-differentiated AIS), polymorphic type (poorly differentiated AIS), and mixed typical and polymorphic type. Three cytological subtypes (endocervical, endometrioid and intestinal subtypes) of AIS were also analyzed.
The sensitivity of the original Papanicolaou smears for the detection of AIS was 44.6%, while that for the detection of AIS and adenocarcinoma was 63.5%. The diagnostic accuracy of AIS increased to 78.5% in the final diagnosis. The common characteristic features were microbiopsies/hyperchromatic crowded groups (HCG) (82.0%) and mitotic figures (72.2%). The appearance of single cells (2.8%) was rare, and all the cervical cytology smears showed no evidence of necrotic tumor diathesis. The most common AIS was the typical type (41 cases, 67.2%) among all cytologically-diagnosed AIS or adenocarcinoma cases (61 cases). Although mixed typical and polymorphic AIS existed in 17 cases (27.9%), pure polymorphic AIS was very rare (3 cases, 4.9%). The endocervical subtype was the most predominant subtype (67.2%), followed by a few mixed subtypes. The important diagnostic keys for AIS cytology are as follows: (1) The appearance of microbiopsies/HCG (single-cell pattern is rare), (2) mitotic figures in the microbiopsies/HCG, (3) a lack of necrotic tumor diathesis in cases with polymorphic AIS, and (4) recognition of typical cytological subtypes.
The relatively low diagnostic accuracy AIS was caused by the underestimation of microbiopsies/HCG and the overestimation of polymorphic components. The typical cytological features of AIS are the presence of microbiopsies/HCG with mitotic figures in the absence of necrotic tumor diathesis in specimens containing endocervical samples. The recognition of infrequent AIS subtypes (endometrioid and intestinal subtypes) is also important.
巴氏涂片检测宫颈原位腺癌（AIS）的敏感性非常低。对宫颈AIS进行全面的细胞学分析对于提高诊断准确性是必要的。
研究对象为74例经病理诊断为AIS的患者。共回顾了140张巴氏涂片，以计算巴氏涂片检测AIS的敏感性以及采样/筛查/诊断错误的发生率。细胞学检查由6名细胞技术人员进行，最终的细胞学诊断在共识会议上得出。我们将病例分为三种分化类型：典型型（高分化AIS）、多形型（低分化AIS）以及典型和多形混合型。还分析了AIS的三种细胞学亚型（宫颈内膜型、子宫内膜样型和肠型）。
原始巴氏涂片检测AIS的敏感性为44.6%，而检测AIS和腺癌的敏感性为63.5%。最终诊断时AIS的诊断准确性提高到了78.5%。常见的特征性表现为微生物活检/核深染拥挤群（HCG）（82.0%）和有丝分裂象（72.2%）。单个细胞出现的情况（2.8%）很少见，并且所有宫颈细胞学涂片均未显示坏死肿瘤素质的证据。在所有经细胞学诊断为AIS或腺癌的病例（61例）中，最常见的AIS类型为典型型（41例，67.2%）。虽然典型和多形混合型AIS有17例（27.9%），但纯多形型AIS非常罕见（3例，4.9%）。宫颈内膜亚型是最主要的亚型（67.2%），其次是少数混合亚型。AIS细胞学的重要诊断要点如下：（1）微生物活检/HCG的表现（单细胞模式罕见），（2）微生物活检/HCG中的有丝分裂象，（3）多形型AIS病例中缺乏坏死肿瘤素质，以及（4）识别典型的细胞学亚型。
AIS相对较低的诊断准确性是由于对微生物活检/HCG的低估和对多形性成分的高估。AIS的典型细胞学特征是在含有宫颈内膜样本的标本中存在带有有丝分裂象的微生物活检/HCG，且无坏死肿瘤素质。识别罕见的AIS亚型（子宫内膜样型和肠型）也很重要。
