Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
Department of Pathology, Queen Mary Hospital, School of Clinical Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
Cancer Med. 2023 Sep;12(17):17581-17591. doi: 10.1002/cam4.6376. Epub 2023 Jul 27.
Endometrial lesions are morphologically diverse and uncommon on cervical smears, with its detection rate and associated diagnostic categories uncharacterized. In this study, cervical smears matched to histologically proven endometrial hyperplasias and carcinomas were reviewed and compared with cervical in-situ-carcinomas/carcinomas, aiming to detail the diagnostic performance of cervical smears for upper tract and glandular lesions.
Pathology reports of cervical smears, hysterectomies, endometrial and cervical biopsies from 1995 to 2021 were retrieved. Diagnoses of cervical smears were matched to endometrial hyperplasias and carcinomas, or cervical carcinomas and reviewed.
Totally 832 cervical smears (272 cervical carcinomas, 312 endometrial carcinomas, and 248 hyperplasias) were included. Considering all cytologic glandular diagnosis as positive, the detection rate of cervical adenocarcinoma-in-situ was the highest (64.3%), followed by cervical adenocarcinoma (63.8%), endometrial carcinoma (31.7%), and hyperplasia (with atypia-8.5%; without atypia-2.3%) (p < 0.001). Endometrial hyperplasia was most often diagnosed as atypical squamous cells of undetermined significance (ASCUS) (5.0%) or atypical glandular cells, not otherwise specified (3.6%) without indication of endometrial origin. For endometrial carcinomas, higher FIGO grading and endocervical involvement were associated with higher detection rates across all diagnostic categories (p = 0.002-0.028). High FIGO grade was associated with suspicious/favor neoplastic (C4) (31.1%vs10.3%, p < 0.001) and carcinoma (C5) (17.8% vs. 5.6%, p = 0.005) categories, but not for all glandular diagnoses combined (33.3% vs. 31.0%, p = 0.761).
Detection rates for endometrial lesions are lower than cervical lesions but not insignificant. Endometrial hyperplasia should be recognized as a differential of human papilloma virus-negative ASCUS and prompt consideration of investigation of the upper genital tract.
子宫内膜病变在宫颈涂片上形态多样且不常见，其检出率和相关诊断类别尚未明确。本研究对经组织学证实的子宫内膜增生症和癌的宫颈涂片进行了回顾性分析，并与宫颈原位癌/癌进行了比较，旨在详细描述宫颈涂片对上生殖道和腺上皮病变的诊断性能。
检索了 1995 年至 2021 年的宫颈涂片、子宫切除术、子宫内膜和宫颈活检的病理报告。将宫颈涂片的诊断与子宫内膜增生症和癌或宫颈癌进行匹配，并进行回顾性分析。
共纳入 832 例宫颈涂片（272 例宫颈癌、312 例子宫内膜癌和 248 例增生症）。如果将所有细胞学腺性诊断均视为阳性，那么宫颈腺癌原位的检出率最高（64.3%），其次是宫颈腺癌（63.8%）、子宫内膜癌（31.7%）和增生症（伴不典型性-8.5%；不伴不典型性-2.3%）（p<0.001）。子宫内膜增生症最常被诊断为非典型意义不明确的鳞状上皮细胞（ASCUS）（5.0%）或非特指的腺细胞不典型（3.6%），而没有子宫内膜来源的提示。对于子宫内膜癌，FIGO 分级越高和宫颈内膜受累越广泛，在所有诊断类别中检出率越高（p=0.002-0.028）。高级别 FIGO 分级与可疑/倾向肿瘤（C4）（31.1%vs10.3%，p<0.001）和癌（C5）（17.8%vs. 5.6%，p=0.005）类别相关，但与所有腺性诊断的组合（33.3%vs. 31.0%，p=0.761）无关。
子宫内膜病变的检出率低于宫颈病变，但并非微不足道。子宫内膜增生症应被视为 HPV 阴性 ASCUS 的鉴别诊断，应及时考虑对女性上生殖道进行检查。
