Kim Mi-Kyung, Lee Yoo Kyung, Hong Sung Ran, Lim Kyung Taek
Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea.
Department of Pathology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea.
Diagn Cytopathol. 2017 Oct;45(10):867-872. doi: 10.1002/dc.23777. Epub 2017 Aug 3.
To evaluate the histologic correlation and clinical significance of atypical glandular cells (AGC) detected on Pap tests.
Pap tests interpreted as AGC were retrieved from an institutional cytopathology database. The AGC subcategories according to the Bethesda system 2001 include atypical glandular cells, not otherwise specified (AGC-NOS), atypical endometrial cells (AEM), and atypical endocervical cells (AEC). Clinicopathologic variables were collected from medical records retrospectively, and histologic follow-up diagnoses were correlated with AGC subcategories.
From January 2009 to December 2014, 741 (0.17%) of 435 778 cervical smears were interpreted as AGC. Of 713 cases included in the study analysis, the distribution of AGC subcategories was as follows: AGC 15.3%, AEM 59.6%, and AEC 25.1%. Of 508 cases with histologic follow-up results, 33.9% of cases were diagnosed to have clinically significant lesions, which include cervical squamous or glandular neoplasia (1.4% and 10.0%), endometrial neoplasia (21.5%), and other metastatic carcinoma (1.0%). Endometrial neoplasia was the most common significant pathology in women aged ≥40 years (28.4%), whereas cervical glandular neoplasia was the most commonly diagnosed lesion in women aged <40 years (14.5%, P < 0.001). When considering past histories which could affect the Pap results, IUD use (10.3%) and pregnancy (7.3%) were most frequently documented. Although IUD users showed low prevalence of significant pathology (2.6%), AGC cases related with pregnancy preceded significant pathologic lesions in 14.3%.
The relatively high incidence of significant neoplasia linked to AGC emphasizes the importance of adherence to the AGC management guidelines which recommend early and intensive investigation using multiple testing modalities.
评估巴氏试验中检测到的非典型腺细胞（AGC）的组织学相关性及临床意义。
从机构细胞病理学数据库中检索被解释为AGC的巴氏试验。根据2001年贝塞斯达系统，AGC亚类包括未明确诊断的非典型腺细胞（AGC-NOS）、非典型子宫内膜细胞（AEM）和非典型宫颈内膜细胞（AEC）。回顾性收集病历中的临床病理变量，并将组织学随访诊断结果与AGC亚类进行关联。
2009年1月至2014年12月，435778例宫颈涂片中有741例（0.17%）被解释为AGC。在纳入研究分析的713例病例中，AGC亚类的分布如下：AGC占15.3%，AEM占59.6%，AEC占25.1%。在508例有组织学随访结果的病例中，33.9%的病例被诊断为有临床意义的病变，包括宫颈鳞状或腺性肿瘤（1.4%和10.0%）、子宫内膜肿瘤（21.5%）和其他转移性癌（1.0%）。子宫内膜肿瘤是40岁及以上女性最常见的有意义病理情况（28.4%），而宫颈腺性肿瘤是40岁以下女性最常诊断出的病变（14.5%，P＜0.001）。在考虑可能影响巴氏试验结果的既往史时，最常记录的是宫内节育器使用史（10.3%）和妊娠史（7.3%）。虽然使用宫内节育器者有意义病理情况的发生率较低（2.6%），但与妊娠相关的AGC病例中有14.3%先于有意义的病理病变出现。
与AGC相关的有意义肿瘤的相对高发生率强调了遵循AGC管理指南的重要性，该指南建议采用多种检测方式进行早期和深入的检查。
