Pambuccian Stefan E
Department of Pathology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois.
J Am Soc Cytopathol. 2015 Jan-Feb;4(1):44-52. doi: 10.1016/j.jasc.2014.10.004. Epub 2014 Nov 4.
The term "atypical" was introduced by the founder of modern cytodiagnosis, Dr. George N. Papanicolaou, to convey a very low suspicion of (pre)malignancy. Despite controversies concerning its ambiguous and imprecise definition and its uncertain optimal use, the term "atypia" has continued to be used in cytopathology, and has recently been increasingly used in standardized nongynecologic cytopathology diagnostic reporting terminologies. Its increasing use suggests that "atypia" continues to be a useful category to fill the gap between what we can recognize as entirely normal (including reactive changes) and what we can recognize as clearly abnormal (premalignant or malignant). However, this diagnosis should be used parsimoniously, since the potential overuse of "atypia" diagnoses can lead to the erosion of clinicians' confidence in cytopathology, their misunderstanding of the cytopathology report, and to an increase the clinicians' diagnostic uncertainty, with negative consequences on patients' satisfaction and wellbeing, and on health care costs. A clinically meaningful, standardized cytodiagnostic category of "atypia" requires a narrow definition, quantitative criteria, agreed-upon reference images, a clear clinical meaning (likelihood of underlying malignancy or premalignancy) and, ideally, well-defined management options. The successful implementation of such a standardized "atypia" diagnostic category requires continuous education of cytology professionals and quality assurance efforts to monitor its use. The interobserver variability and potential excessive use of the diagnosis of "atypia" may be reduced by considering and addressing the major factors involved in its variable use, namely the quality of the sample, the definition of "atypia", the education/training of the cytologist/pathologist, and cytologist/pathologist-related "supracytologic" factors.
“非典型”一词由现代细胞诊断学创始人乔治·N·帕潘尼古拉乌博士引入，用以表达对（癌）前病变的极低怀疑度。尽管关于其定义模糊不清、不够精确以及最佳使用方式存在争议，但“非典型性”一词仍在细胞病理学中持续使用，且最近在标准化非妇科细胞病理学诊断报告术语中使用得越来越多。其使用频率的增加表明，“非典型性”仍然是一个有用的类别，用于填补我们可认定为完全正常（包括反应性改变）与可认定为明显异常（癌前或恶性）之间的空白。然而，这种诊断应谨慎使用，因为“非典型性”诊断的潜在过度使用可能导致临床医生对细胞病理学的信心受到侵蚀、对细胞病理学报告产生误解，并增加临床医生的诊断不确定性，从而对患者的满意度和健康状况以及医疗成本产生负面影响。一个具有临床意义的、标准化的细胞诊断“非典型性”类别需要一个狭义的定义、定量标准、公认的参考图像、明确的临床意义（潜在恶性或癌前病变的可能性），理想情况下还需要明确的管理方案。成功实施这样一个标准化的“非典型性”诊断类别需要对细胞学专业人员进行持续教育，并开展质量保证工作以监测其使用情况。通过考虑并解决其使用差异所涉及的主要因素，即样本质量、“非典型性”的定义、细胞学家/病理学家的教育/培训以及与细胞学家/病理学家相关的“超细胞”因素，可以减少“非典型性”诊断的观察者间差异和潜在的过度使用。
