Laverty C R, Farnsworth A, Thurloe J, Bowditch R
Aust N Z J Obstet Gynaecol. 1988 Nov;28(4):307-12. doi: 10.1111/j.1479-828x.1988.tb01688.x.
A spectrum of changes precedes clinical invasive adenocarcinoma of the cervix. Cytological and histological criteria for the diagnosis of adenocarcinoma in situ (ACIS) are becoming more clearly defined. A 5-year prospective study was undertaken to test the accuracy of a cytological prediction of ACIS. From a total of 290,000 cervical smears 54 predictions of ACIS were made: 33 (61%) alone and 21 (39%) with associated squamous carcinoma in situ (SCIS). The rate of reporting ACIS was compared to the rates for intraepithelial and invasive squamous lesions and for frank invasive adenocarcinoma. The findings suggest that ACIS is being underdiagnosed. Forty-seven patients were adequately investigated; 46 had intraepithelial or invasive malignancy. There were 10 cases of ACIS, 10 ACIS with SCIS, 9 microinvasive adenocarcinoma, 5 invasive adenocarcinoma, 2 microinvasive adenosquamous carcinomas, 1 invasive adenosquamous carcinoma, 8 SCIS and 1 endometrial carcinoma. There was one true false positive report. Thus cervical glandular neoplasia was confirmed in 37 patients (79%), 13 of these having adenosquamous tumours. Because 98% of patients had in situ or invasive malignancy and because 36% of cases were invasive (though mostly microinvasive) prompt investigation, by cone biopsy, must follow a cytological report of ACIS.
在宫颈临床浸润性腺癌出现之前会有一系列变化。原位腺癌（ACIS）的细胞学和组织学诊断标准正变得越来越明确。一项为期5年的前瞻性研究旨在检验ACIS细胞学预测的准确性。在总共290,000份宫颈涂片样本中，做出了54例ACIS预测：单独诊断为ACIS的有33例（61%），伴有原位鳞状细胞癌（SCIS）的有21例（39%）。将ACIS的报告率与上皮内和浸润性鳞状病变以及明显浸润性腺癌的报告率进行了比较。研究结果表明ACIS存在诊断不足的情况。对47例患者进行了充分调查；其中46例患有上皮内或浸润性恶性肿瘤。包括10例ACIS、10例伴有SCIS的ACIS、9例微浸润性腺癌、5例浸润性腺癌、2例微浸润腺鳞癌、1例浸润腺鳞癌、8例SCIS和1例子宫内膜癌。有1例假阳性报告。因此，37例患者（79%）确诊为宫颈腺性肿瘤，其中13例患有腺鳞肿瘤。由于98%的患者患有原位或浸润性恶性肿瘤，且36%的病例为浸润性（尽管大多为微浸润性），所以在ACIS细胞学报告后必须通过锥形活检进行及时调查。
