Kawano Kouichiro, Yamaguchi Tomohiko, Nasu Hiroki, Nishio Shin, Ushijima Kimio
Department of Obstetrics and Gynecology, Kurume University, School of Medicine, Kurume, Japan.
Division of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
Diagn Cytopathol. 2020 Dec;48(12):1224-1229. doi: 10.1002/dc.24549. Epub 2020 Jul 15.
In the subcategorization of atypical glandular cells (AGCs), origin of cells should be mentioned to estimate lesion sites for diagnosis. However, cases without subcategorization are often encountered due to limited reproducibility. We evaluated whether the subcategorization of AGC based on the Bethesda terminology can estimate lesion sites.
We retrospectively investigated cases whose cervical smears were interpreted as AGC and underwent pathological assessment at our institution between June 2009 and September 2017. AGC was subcategorized based on the Bethesda System. Not-otherwise-specified (NOS) was subcategorized into endocervical cells (NOS-EC), endometrial cells (NOS-EM), or glandular cells (NOS-G). Favor neoplastic (FN) was subcategorized into endocervical cells (FN-EC) or glandular cells (FN-G). FN-G was further subcategorized into endometrial cells (FN-EM) or unknown origin (FN-UO). Clinicopathological data were retrieved from the medical records.
Of 88 AGC cases, there were 30 NOS-EC (34.1%), 2 NOS-EM (2.3%), 25 FN-EC (28.4%), 22 FN-EM (25.0%), and 9 FN-UO (10.2%). A significantly higher proportion of neoplastic lesions occurred in FN than in NOS (P <.001). The concordance of AGC subclass and lesion site was 88.0%, 70.7%, and 77.3% in FN-EC, FN-G, and FN-EM, respectively. The concordance of FN-EM and lesion site increased to 88.9% in patients aged >50 years. Of nine cases of FN-UO, six experienced nonendometrioid endometrial cancer and extrauterine malignancy.
Subcategorization of NOS and FN would be useful in estimating neoplastic lesions. Further subcategorization into FN-EC, FN-EM, and FN-UO would similarly be beneficial in estimating the lesion site, especially for small endometrial and extrauterine lesions.
在非典型腺细胞（AGC）的亚分类中，应提及细胞起源以评估诊断的病变部位。然而，由于可重复性有限，经常会遇到未进行亚分类的病例。我们评估了基于贝塞斯达术语的AGC亚分类是否能够评估病变部位。
我们回顾性研究了2009年6月至2017年9月期间在本机构宫颈涂片被解读为AGC并接受病理评估的病例。AGC根据贝塞斯达系统进行亚分类。未另行指定（NOS）被亚分类为宫颈管内膜细胞（NOS-EC）、子宫内膜细胞（NOS-EM）或腺细胞（NOS-G）。倾向肿瘤性（FN）被亚分类为宫颈管内膜细胞（FN-EC）或腺细胞（FN-G）。FN-G进一步亚分类为子宫内膜细胞（FN-EM）或来源不明（FN-UO）。临床病理数据从病历中获取。
在88例AGC病例中，有30例NOS-EC（34.1%）、2例NOS-EM（2.3%）、25例FN-EC（28.4%）、22例FN-EM（25.0%）和9例FN-UO（10.2%）。肿瘤性病变在FN中的比例显著高于NOS（P＜0.001）。在FN-EC、FN-G和FN-EM中，AGC亚类与病变部位的一致性分别为88.0%、70.7%和77.3%。在年龄＞50岁的患者中，FN-EM与病变部位的一致性增加到88.9%。在9例FN-UO病例中，6例发生了非子宫内膜样子宫内膜癌和子宫外恶性肿瘤。
NOS和FN的亚分类有助于评估肿瘤性病变。进一步亚分类为FN-EC、FN-EM和FN-UO同样有助于评估病变部位，特别是对于小的子宫内膜和子宫外病变。
