Pathology, Fimlab Laboratories, Tampere, Finland.
Faculty of Social Sciences, Tampere University, Tampere, Finland.
APMIS. 2021 Apr;129(4):195-203. doi: 10.1111/apm.13115. Epub 2021 Feb 2.
In the high-income countries, the amount of cervical adenocarcinomas is on the rise. The pap smear sampling has a low sensitivity and a low specificity for endocervical malignancies, and there are only a few cytomorphological features, that are specifically associated with glandular atypia. In this study, 298 pap smears of 60 patients with endocervical adenocarcinoma or adenocarcinoma in situ (AIS) and 30 patients with high-grade intraepithelial lesion (HSIL) in histology were reviewed. The pap smear type (screening/clinical), the HPV status and the time from sampling to the histological confirmation of diagnosis were recorded for each case. Despite that no cytomorphological features could be associated with adenocarcinoma statistically, 70% of the pap smears were initially correctly diagnosed as an endocervical glandular lesion. Palisading cell borders, nuclear pleomorphism and the lack of single atypical cells present simultaneously were found to be associated with adenocarcinoma and AIS with the corresponding ORs of 5.89 (95% CI 1.96-17.70), 3.71 (95% CI 1.14-12.02) and 10.76 (95% CI 1.20-59.50). This combination of features was seen in smears taken up to 5 years before the histological diagnosis. Of all our screening samples, 10.9% were HPV-positive. There were no HPV-negative samples among patients with adenocarcinoma.
在高收入国家，宫颈腺癌的数量呈上升趋势。巴氏涂片取样对宫颈恶性肿瘤的灵敏度和特异性较低，并且只有少数细胞学特征与腺体异型性特异性相关。在这项研究中，对 60 例宫颈腺癌或原位腺癌（AIS）患者和 30 例组织学高级别上皮内病变（HSIL）患者的 298 例巴氏涂片进行了回顾性分析。记录了每个病例的巴氏涂片类型（筛查/临床）、HPV 状态以及从取样到组织学确诊的时间。尽管没有细胞学特征可以与腺癌统计学相关，但 70%的巴氏涂片最初被正确诊断为宫颈腺上皮病变。发现栅栏状细胞边界、核多形性和缺乏单个异型细胞同时存在与腺癌和 AIS 相关，相应的 OR 值分别为 5.89（95%CI 1.96-17.70）、3.71（95%CI 1.14-12.02）和 10.76（95%CI 1.20-59.50）。这些特征组合在组织学诊断前长达 5 年的涂片上可见。在我们所有的筛查样本中，10.9%为 HPV 阳性。腺癌患者中没有 HPV 阴性样本。
