Rimm D L, Gmitro S, Frable W J
Department of Pathology, yale University School of Medicine, New Haven, CT 06510, USA.
Diagn Cytopathol. 1996 Jun;14(4):374-9. doi: 10.1002/(SICI)1097-0339(199605)14:4<374::AID-DC17>3.0.CO;2-H.
The Bethesda System for classifying cervical/vaginal smears has divided reparative changes into two categories: typical and atypical. Although atypical repair may be grouped with atypical squamous cells of unknown significance (ASCUS), this study selected cases specifically diagnosed as atypical reparative changes (ARC), which showed streaming sheets of cells and enlarged nuclei with nucleoli and anisonucleosis. Our goal was to determine the validity of grouping atypical repair with ASCUS. All cases were received by the Medical College of Virginia-Virginia Commonwealth University (MCV-VCU) pathology department in a 6-month period in 1993. Of 196 cases, 55 (28%) were biopsied within a subsequent 3-6-month period. Of these, 27 also carried a diagnosis of ASCUS (9), low-grade squamous intraepithelial lesion (LGSIL) (15), or high-grade squamous intraepithelial lesion (HGSIL) (3). The remaining 28 were presumably biopsied on the basis of clinical concern regarding a diagnosis of ARC. This group, which represents only 14% of the total with the ARC diagnosis, showed a spectrum of histologic changes from squamous metaplasia and chronic cervicitis to HGSIL. Surprisingly, 25% of these patients (7 of 28) showed changes of LGSIL or higher, including 2 (7%) showing HGSIL. This level of higher grade histologic findings justifies separation of atypical from typical repair. Although there are some cases with a significant histologic abnormality found with a cytologic diagnosis of ARC, the percentage of cases is not nearly as high as the 60% range seen associated with the diagnosis of ASCUS. Due to the lack of consensus on the clinical management of ASCUS, we find no justification to separate the diagnosis of ARC from that of ASCUS.
贝塞斯达系统对宫颈/阴道涂片的分类将修复性改变分为两类：典型性和非典型性。虽然非典型修复可能与意义不明确的非典型鳞状细胞（ASCUS）归为一组，但本研究选取了明确诊断为非典型修复性改变（ARC）的病例，这些病例表现为细胞呈条索状排列，细胞核增大，可见核仁及核大小不等。我们的目的是确定将非典型修复与ASCUS归为一组是否合理。所有病例均于1993年6个月内由弗吉尼亚联邦大学医学院（MCV-VCU）病理科接收。在196例病例中，55例（28%）在随后的3至6个月内接受了活检。其中，27例还被诊断为ASCUS（9例）、低级别鳞状上皮内病变（LGSIL）（15例）或高级别鳞状上皮内病变（HGSIL）（3例）。其余28例可能是基于对ARC诊断的临床担忧而进行活检。该组仅占ARC诊断总数的14%，显示出从鳞状化生、慢性宫颈炎到HGSIL的一系列组织学变化。令人惊讶的是，这些患者中有25%（28例中的7例）表现出LGSIL或更高级别的变化，其中2例（7%）表现为HGSIL。这种更高级别组织学发现的水平证明了非典型修复与典型修复应分开。虽然有一些细胞学诊断为ARC的病例存在明显的组织学异常，但病例百分比远不及与ASCUS诊断相关的60%范围。由于对ASCUS的临床管理缺乏共识，我们认为没有理由将ARC的诊断与ASCUS的诊断分开。
