Kline M J, Davey D D
Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center, Lexington 40536-0093, USA.
Diagn Cytopathol. 1996 Jun;14(4):380-4. doi: 10.1002/(SICI)1097-0339(199605)14:4<380::AID-DC18>3.0.CO;2-G.
The Bethesda System recommends that the diagnosis of "atypical squamous cells of undetermined significance" (ASCUS) be qualified when possible to indicate whether a reactive process, or a squamous intraepithelial lesion (SIL), is favored. In order to evaluate the utility of this recommendation, 308 cervicovaginal smears diagnosed as ASCUS favoring a reactive (FR) or dysplastic (FD) process were identified. Concurrent or follow-up biopsies and cervicovaginal smear results were reviewed and compared to the follow-up of 103 cervicovaginal smears diagnosed as ASCUS without qualification. A follow-up diagnosis of SIL was found in 46.5%, 29.5% and 26.2% of the ASCUS FD, ASCUS FR, and ASCUS unqualified cases, respectively. A repeated ASCUS diagnosis was found in 20.4%, 21.8%, and 18.4% of the ASCUS FD, ASCUS FR, and ASCUS unqualified cases, respectively. Follow-up of each group was negative for dysplasia in 30.0%, 48.7%, and 54.4% of the ASCUS FD, ASCUS FR, and ASCUS unqualified cases, respectively. These results support the use of an ASCUS FD category for the increased detection of patients with dysplasia. The ASCUS FR category was not helpful in our laboratory. Follow-up studies of qualified ASCUS cases in individual practice settings may be useful in guiding patient management.
贝塞斯达系统建议，在可能的情况下，对“意义不明确的非典型鳞状细胞”（ASCUS）的诊断进行限定，以表明更倾向于反应性过程还是鳞状上皮内病变（SIL）。为了评估该建议的实用性，我们识别出308例诊断为ASCUS且更倾向于反应性（FR）或发育异常（FD）过程的宫颈阴道涂片。回顾并比较了同期或后续活检及宫颈阴道涂片结果，以及103例未经限定诊断为ASCUS的宫颈阴道涂片的后续情况。在ASCUS FD、ASCUS FR和未限定的ASCUS病例中，分别有46.5%、29.5%和26.2%的病例后续诊断为SIL。在ASCUS FD、ASCUS FR和未限定的ASCUS病例中，分别有20.4%、21.8%和18.4%的病例重复诊断为ASCUS。在ASCUS FD、ASCUS FR和未限定的ASCUS病例中，每组分别有30.0%、48.7%和54.4%的病例后续发育异常诊断为阴性。这些结果支持使用ASCUS FD类别来增加对发育异常患者的检测。ASCUS FR类别在我们实验室中并无帮助。在个体临床实践环境中对限定的ASCUS病例进行后续研究可能有助于指导患者管理。
