Gupta P K, Shurbaji M S, Mintor L J, Ermatinger S V, Myers J, Quinn T C
Department of Pathology, Johns Hopkins Hospital, Baltimore, MD.
Diagn Cytopathol. 1988;4(3):224-9. doi: 10.1002/dc.2840040309.
The value of the Papanicolaou-stained vaginopancervical (Fast) smear in the detection of chlamydial infection has been disputed. We examined 116 satisfactory Fast smears from 203 women enrolled in the Johns Hopkins Fertility Control Clinic and compared tissue-culture results with cytopathologic detection using various published morphologic criteria. All Chlamydia culture-positive cases were reviewed, and certain cytologic features considered helpful in the detection of chlamydial infection in cervical smears obtained from this selected high-risk population were identified. The changes that had the highest correlation with tissue culture included fine vacuolation of metaplastic endocervical cells, giving their cytoplasm a rarefied "moth-eaten" appearance. Using these criteria, cytopathologic changes of chlamydial infection were observed in 24 of 28 cases of tissue-culture-positive cases and in 8 of 88 tissue-culture-negative cases. The sensitivity and specificity of the Fast-smear cytodiagnosis of Chlamydia infection utilizing these morphologic changes and compared with tissue culture were 86% and 91%, respectively. Other cytologic features, including inflammatory background and intracytoplasmic structures consistent with initial and intermediate chlamydial bodies within the metaplastic cells, were found to be useful although less specific and less sensitive. The implications of these diagnostic features, the conditions to be considered in their differential diagnosis, and the pitfalls of chlamydial cytodiagnosis and the chlamydia culture studies have been critically reviewed. Study design and the high unsatisfactory cervical smear rate are discussed.
巴氏染色的阴道宫颈（快速）涂片在衣原体感染检测中的价值一直存在争议。我们检查了约翰霍普金斯生育控制诊所招募的203名女性的116份满意的快速涂片，并将组织培养结果与使用各种已发表形态学标准的细胞病理学检测结果进行了比较。对所有衣原体培养阳性病例进行了复查，并确定了某些有助于在从这一选定的高危人群中获得的宫颈涂片中检测衣原体感染的细胞学特征。与组织培养相关性最高的变化包括化生的宫颈内膜细胞出现细微空泡，使其细胞质呈现稀疏的“虫蚀样”外观。使用这些标准，在28例组织培养阳性病例中的24例以及88例组织培养阴性病例中的8例中观察到了衣原体感染的细胞病理学变化。利用这些形态学变化并与组织培养相比，快速涂片对衣原体感染进行细胞诊断的敏感性和特异性分别为86%和91%。其他细胞学特征，包括炎症背景以及化生细胞内与初始和中间衣原体包涵体一致的胞质内结构，虽然特异性和敏感性较低，但也被发现是有用的。对这些诊断特征的意义、鉴别诊断中应考虑的情况以及衣原体细胞诊断和衣原体培养研究的陷阱进行了严格审查。讨论了研究设计和宫颈涂片高不满意率的问题。
