Preventive Oncology Center, Faculty of Medicine, University of Chile, Santiago, Chile.
Diagn Cytopathol. 2020 Sep;48(9):852-856. doi: 10.1002/dc.24421. Epub 2020 Apr 2.
The standard screening test for detecting cervical lesions and cancers is a Papanicolaou (Pap) smear. While squamous cell abnormalities remain the most common positive Pap test result, cytologic findings of glandular cell abnormalities have become more frequent in recent decades. The 2014 Bethesda System for reporting cervical cytology includes the classification "atypical glandular cells" (AGC). AGC have morphological abnormalities that fall outside the range of reactive changes, but are insufficient for a diagnosis of invasive adenocarcinoma. In several histologic follow-up studies, most AGC cases were found to represent a benign condition. In the current study, we evaluate the significance of AGC cytology findings by analyzing the histologic follow-up results of a large number of patients with AGC. Most patients with AGC in this study were found to have a significant lesion on follow-up (63.9%), with negative histologic results in only 36.1% of patients. Among patients with significant lesions, the most common result was low-grade squamous intraepithelial lesion (26.6%), followed by high-grade squamous intraepithelial lesion (23.2%). This provides further evidence to support the Chilean Clinical Guidelines for Cervical Cancer, which recommends diagnostic follow-up studies in all women with AGC to minimize the chance of undetected serious cervical disease.
检测宫颈病变和癌症的标准筛查试验是巴氏涂片（Pap）检查。虽然鳞状细胞异常仍然是最常见的阳性 Pap 试验结果，但近年来细胞学发现的腺细胞异常变得更加频繁。2014 年的宫颈细胞学报告贝塞斯达系统包括“非典型腺细胞”（AGC）的分类。AGC 具有超出反应性变化范围的形态学异常，但不足以诊断为浸润性腺癌。在几项组织学随访研究中，大多数 AGC 病例被发现代表良性病变。在本研究中，我们通过分析大量 AGC 患者的组织学随访结果来评估 AGC 细胞学发现的意义。本研究中大多数 AGC 患者在随访时发现有明显病变（63.9%），仅有 36.1%的患者组织学结果为阴性。在有明显病变的患者中，最常见的结果是低级别鳞状上皮内病变（26.6%），其次是高级别鳞状上皮内病变（23.2%）。这进一步证明了智利宫颈癌临床指南的正确性，该指南建议对所有 AGC 妇女进行诊断性随访研究，以最大程度地减少未发现的严重宫颈疾病的机会。
