Harbhajanka Aparna, Chahar Satyapal, Michael Claire W
Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Diagn Cytopathol. 2019 Feb;47(2):88-93. doi: 10.1002/dc.24024. Epub 2018 Nov 19.
Although the incidence of glandular cell abnormalities (GCA) on cervical cytology is low, the clinical and histologic findings are often significant. A combined diagnosis of squamous intraepithelial lesion (SIL) and GCA indicates concern for either two distinct lesions or single entity. The goal of this study is to evaluate the outcome of the diagnosis of GCA alone or in combination with squamous abnormality (SqA).
From January 2012-June 2017, our laboratory processed 162 088 ThinPrep Pap tests. 998 (0.61%) cases were reported as GCA. Histologic follow-up was available in 569 cases after excluding adenocarcinoma, NOS and atypical endometrial cells. HPV results were available in 429 (67.2%) cases.
The surgical follow-up on 271 cases with GCA alone diagnosis revealed negative/benign lesions in 183 (67.5%) cases, glandular lesions in 40 (14.8%) cases; SqA in 47 (17.3%) cases; combined in 1 (0.4%) case. Surgical follow-up on 298 cases with dual interpretation revealed negative/benign lesions in 108 (36.2%) cases, SqA in 159 (53.4%) cases, GCA in 21 (7.0%) cases and only 10 (3.4%) cases were combined lesions. The mean age was 44 ±13.36 years. The overall hrHPV-positive rate was 36.2%. Endometrial carcinoma was most common abnormality in patients >65 years (71.4%) especially with hrHPV-negative results. CIN 1-3 was the most common finding in patients <30 years (50%).
A cytological diagnosis of GCA has a higher risk of glandular abnormality on surgical follow-up especially in the older and hrHPV-negative group (P < .0001) while a combined diagnosis has a higher risk of a squamous lesion especially in <30 years (P < .0001). The combination of cytology, hrHPV-status and patient age can significantly aid in the stratification of the patient into high risk for glandular/squamous lesions which results in appropriate management.
尽管宫颈细胞学检查中腺细胞异常（GCA）的发生率较低，但临床和组织学检查结果往往具有重要意义。鳞状上皮内病变（SIL）和GCA的联合诊断表明可能存在两种不同病变或单一实体病变。本研究的目的是评估单独诊断GCA或与鳞状异常（SqA）联合诊断的结果。
2012年1月至2017年6月，我们实验室共处理了162088例ThinPrep巴氏试验。998例（0.61%）报告为GCA。排除腺癌、未特指型和非典型子宫内膜细胞后，569例有组织学随访结果。429例（67.2%）有HPV检测结果。
对271例单独诊断为GCA的病例进行手术随访，发现183例（67.5%）为阴性/良性病变，40例（14.8%）为腺性病变，47例（17.3%）为SqA，1例（0.4%）为联合病变。对298例联合诊断的病例进行手术随访，发现108例（36.2%）为阴性/良性病变，159例（53.4%）为SqA，21例（7.0%）为GCA，仅10例（3.4%）为联合病变。平均年龄为44±13.36岁。总体高危型人乳头瘤病毒（hrHPV）阳性率为36.2%。子宫内膜癌是65岁以上患者中最常见的异常（71.4%），尤其是hrHPV检测结果为阴性的患者。宫颈上皮内瘤变1-3级是30岁以下患者中最常见的检查结果（50%）。
GCA的细胞学诊断在手术随访中出现腺性异常的风险较高，尤其是在年龄较大和hrHPV阴性的人群中（P<0.0001），而联合诊断出现鳞状病变的风险较高，尤其是在30岁以下人群中（P<0.0001）。细胞学检查、hrHPV状态和患者年龄相结合可显著有助于将患者分层为腺性/鳞状病变高危人群，从而进行适当的管理。
