Howell L P, Davis R L
Department of Pathology, University of California, Sacramento 95718, USA.
Diagn Cytopathol. 1996 Feb;14(1):20-4. doi: 10.1002/(SICI)1097-0339(199602)14:1<20::AID-DC5>3.0.CO;2-Z.
In the first year since the institution of the Bethesda system at UCDMC, 549/7,388 (7.43%) Papanicolaou (Pap) smears were diagnosed as having an epithelial abnormality. One hundred ninety-three of the 549 (35.1%) of the abnormal smears received an ASCUS diagnosis, representing 2.61% of the total volume. Follow-up was obtained on 124/193 (64.2%) and consisted of colposcopy with biopsy in 38.3%, one repeat Pap smear in 51.2%, and two or more repeat Pap smears in 10.5%. Follow-up revealed a squamous intraepithelial lesion (SIL) in 29.1%, ASCUS in 12.9%, and no evidence of an epithelial lesion in 58.0%. Review of the original ASCUS Pap smear from the group with no epithelial lesion on follow-up showed increased inflammation plus metaplasia and/or reactive changes in 69.5% and ASCUS in 19.5%. This study demonstrates that a significant percentage of ASCUS Pap smears represent SIL. However, many Pap smears with reactive, inflammatory changes are misclassified as ASCUS and would be best diagnosed under "Reactive/Reparative Changes" in the Bethesda system. Careful attention to criteria for ASCUS and inflammatory and reactive atypia is recommended to avoid misclassification and to make this category more meaningful to the clinician.
在加州大学戴维斯分校医学中心采用贝塞斯达系统的第一年，7388份巴氏涂片中有549份（7.43%）被诊断为上皮细胞异常。549份异常涂片中，193份（35.1%）被诊断为意义不明确的非典型鳞状细胞（ASCUS），占总量的2.61%。对193份中的124份（64.2%）进行了随访，其中38.3%进行了阴道镜检查及活检，51.2%进行了一次重复巴氏涂片检查，10.5%进行了两次或更多次重复巴氏涂片检查。随访结果显示，29.1%为鳞状上皮内病变（SIL），12.9%为ASCUS，58.0%未发现上皮病变。对随访时未发现上皮病变组的原始ASCUS巴氏涂片进行复查，结果显示69.5%有炎症加重伴化生和/或反应性改变，19.5%为ASCUS。本研究表明，相当比例的ASCUS巴氏涂片代表SIL。然而，许多有反应性、炎症性改变的巴氏涂片被错误分类为ASCUS，在贝塞斯达系统中最好诊断为“反应性/修复性改变”。建议仔细关注ASCUS以及炎症和反应性异型性的标准，以避免错误分类，并使该类别对临床医生更有意义。
