Eddy G L, Ural S H, Strumpf K B, Wojtowycz M A, Piraino P S, Mazur M T
Department of Obstetrics and Gynecology, State University of New York-Health Science Center, Syracuse 13210, USA.
Gynecol Oncol. 1997 Oct;67(1):51-5. doi: 10.1006/gyno.1997.4837.
To establish the frequency of the atypical glandular cells of uncertain significance (AGCUS) category, and its subcategories, as defined by the Bethesda System (TBS).
Our computerized records of cervical/vaginal cytology specimens submitted from January 1, 1993, through December 31, 1995, were retrospectively reviewed for specimens diagnosed as AGCUS. When appropriate, our subcategory of "AGCUS favor premalignant/malignant lesion" was further qualified as "favor endocervical adenocarcinoma in situ" or "suspicious for endometrial carcinoma." The number of specimens and patients diagnosed for each subcategory were grouped by calendar year. Differences in frequency between time periods were tested for statistical significance using chi 2 analysis.
AGCUS was diagnosed in 1181 of 177,715 submitted specimens (0.66%). The frequency of subcategories was as follows: "favor reactive" (65%), "unable to further classify" (30%), "favor premalignant/malignant" (2.9%), "suspicious for endometrial carcinoma" (1.9%), and "favor endocervical adenocarcinoma in situ" (0.4%). From 1993 to 1995 there was an increase in the rate of diagnosis of AGCUS (0.55 to 0.73%; P < 0.001) and a decrease in the percentage of specimens with AGCUS subclassified as "favor premalignant/malignant" (6.2 to 0.5%; P < 0.001). Other subcategories showed no significant change in frequency over this time period. The rate of biopsy-proven preinvasive or invasive lesions in AGCUS patients also showed no significant change from year to year over this time period.
The AGCUS diagnosis can be anticipated at a low but consistent rate from a cytology laboratory using TBS. Any comparison of laboratories should take into consideration the change in reporting frequencies that occurs as part of the "learning curve" following introduction of TBS reporting. Uniform diagnostic criteria and additional reports with large numbers of cytologic specimens will be needed to establish the expected frequency of AGCUS and its subcategories.
确定按照贝塞斯达系统（TBS）定义的意义不明确的非典型腺细胞（AGCUS）类别及其亚类的出现频率。
回顾性分析1993年1月1日至1995年12月31日提交的宫颈/阴道细胞学标本的计算机记录，以查找诊断为AGCUS的标本。在适当情况下，将我们的“AGCUS倾向于癌前/恶性病变”亚类进一步限定为“倾向于宫颈原位腺癌”或“怀疑子宫内膜癌”。每个亚类诊断的标本数和患者数按日历年分组。使用卡方分析检验不同时间段之间频率的差异是否具有统计学意义。
在提交的177,715份标本中，有1181份诊断为AGCUS（0.66%）。亚类的频率如下：“倾向于反应性”（65%）、“无法进一步分类”（30%）、“倾向于癌前/恶性”（2.9%）、“怀疑子宫内膜癌”（1.9%）和“倾向于宫颈原位腺癌”（0.4%）。从1993年到1995年，AGCUS的诊断率有所增加（从0.55%增至0.73%；P<0.001），而分类为“倾向于癌前/恶性”的AGCUS标本百分比有所下降（从6.2%降至0.5%；P<0.001）。在此时间段内，其他亚类的频率没有显著变化。在此时间段内，AGCUS患者中经活检证实的浸润前或浸润性病变的发生率也没有逐年显著变化。
使用TBS的细胞学实验室可以以较低但稳定的频率预期AGCUS诊断。实验室之间的任何比较都应考虑到引入TBS报告后作为“学习曲线”一部分出现的报告频率变化。需要统一的诊断标准和大量细胞学标本的额外报告来确定AGCUS及其亚类的预期频率。
