Department of Pathology, Fimlab Laboratories, Tampere, Finland.
Tampere University, Faculty of Social Sciences, Tampere, Finland.
Acta Cytol. 2023;67(6):604-617. doi: 10.1159/000533256. Epub 2023 Aug 10.
Endocervical glandular atypia is relatively rarely diagnosed by Pap smears. A significant proportion of follow-up histological samples show no premalignant or malignant lesions. The observed cytomorphological findings in premalignant glandular lesions overlap with histologically proven reactive lesions.
A total of 45 conventional Pap smears diagnosed as atypical endocervical cells, not otherwise specified (AEC, NOS) with human papillomavirus (HPV) status available were blindly evaluated in a search for 38 cytomorphological features representing background, architectural, cellular, and nuclear features. Of the cases, 30 represented histologically proven benign changes, and 15 represented histologically proven adenocarcinoma in situ (AIS) or endocervical adenocarcinoma (EAC) cases. The benign biopsies were re-evaluated, and the associations of the cytomorphological features or combinations of them with specific histological features and entities were statistically examined.
The most frequent histological findings in the benign group were squamous metaplasia, inflammation, tubal metaplasia, and microglandular hyperplasia. The statistical analysis revealed cytological features associated with squamous metaplastic changes, inflammation, and microglandular hyperplasia. Unfortunately, no cytomorphological feature was sufficiently specific to confidently leave the lesion without follow-up and histological correlation. Degeneration and nuclear crowding were the most salient features that distinguished the instances of glandular atypia with benign follow-up histology from those with histologically proven AIS or EAC (26.7 vs. 60.0%, p = 0.030, and 50.0 vs. 86.7%, p = 0.017).
Additional methods besides cytomorphology are required to reliably distinguish smears with AEC, NOS harbouring only benign histological changes from those exhibiting endocervical glandular malignancy.
巴氏涂片诊断宫颈腺上皮不典型性相对较少。很大一部分后续的组织学样本没有显示出癌前病变或恶性病变。在癌前腺上皮病变中观察到的细胞形态学发现与经组织学证实的反应性病变重叠。
总共对 45 例常规巴氏涂片诊断为不典型宫颈腺细胞，未特指（AEC，NOS）且有人类乳头瘤病毒（HPV）状态的病例进行了盲法评估，以寻找 38 种代表背景、结构、细胞和核特征的细胞形态学特征。在这些病例中，30 例为经组织学证实的良性变化，15 例为经组织学证实的原位腺癌（AIS）或宫颈腺癌（EAC）病例。对良性活检进行了重新评估，并对细胞形态学特征或其组合与特定组织学特征和实体的关联进行了统计学检查。
良性组最常见的组织学发现是鳞状上皮化生、炎症、输卵管上皮化生和微小腺体增生。统计分析显示与鳞状上皮化生、炎症和微小腺体增生相关的细胞学特征。不幸的是，没有任何细胞学特征具有足够的特异性，可以在没有随访和组织学相关性的情况下自信地处理病变。退化和核拥挤是将具有良性随访组织学的腺上皮不典型性病例与经组织学证实的 AIS 或 EAC 病例区分开来的最显著特征（26.7%对 60.0%，p=0.030，50.0%对 86.7%，p=0.017）。
除了细胞形态学之外，还需要其他方法来可靠地区分仅具有良性组织学变化的 AEC，NOS 涂片与表现出宫颈腺恶性肿瘤的涂片。
