Ashfaq R, Gibbons D, Vela C, Saboorian M H, Iliya F
Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235-9073, USA.
Acta Cytol. 1999 Jan-Feb;43(1):81-5. doi: 10.1159/000330872.
Although the ThinPrep Pap Test is replacing conventional Pap smears in many clinical practices, experience with the identification of glandular lesions is limited. In this study, ThinPrep cytology of glandular lesions was evaluated in a large, inner city teaching hospital with high rates of glandular abnormality.
Six months of ThinPrep diagnoses in 1998, following nearly 100% conversion of the laboratory to the ThinPrep Pap Test, were compared to January-December 1997 conventional smear diagnoses for glandular disease. Biopsy confirmation was evaluated for these cases. Findings on all biopsy-confirmed glandular cases were also compared to findings on cytology.
Similar overall rates of glandular cytology were found. For conventional smears (12 months), 46 cases were diagnosed out of 43,289 smears (0.11%). For ThinPrep cytology (six months), 36 cases were diagnosed out of 25,783 slides (0.14%, P = NS). In the year 1997, 9 biopsy-confirmed conventional smear diagnoses of adenocarcinoma in situ (AIS) or adenocarcinoma were noted versus 10 for six months of 1998 for the ThinPrep method. A statistically significant reduction in the number of miscellaneous nonglandular (squamous) biopsy diagnoses were found with ThinPrep glandular cytology (14 vs. 4 cases, P < .05). For known biopsy-confirmed glandular cases of AIS or adenocarcinoma, a statistically significant reduction in the cytology false negative rate was noted with the ThinPrep method (17 vs. 4 cases, P < .02).
The ThinPrep method provides more accurate diagnoses of glandular disease, with an increase in both sensitivity and specificity for glandular lesions.
尽管在许多临床实践中，薄层液基细胞学检测（ThinPrep Pap Test）正在取代传统巴氏涂片检查，但对腺性病变的识别经验有限。在本研究中，我们在一家腺性异常发生率较高的市中心教学医院，对腺性病变的薄层液基细胞学检测进行了评估。
在实验室几乎100%转换为薄层液基细胞学检测后，将1998年6个月的薄层液基细胞学诊断结果与1997年1月至12月的腺性疾病传统涂片诊断结果进行比较。对这些病例的活检确诊情况进行评估。还将所有活检确诊的腺性病例的检查结果与细胞学检查结果进行比较。
发现腺性细胞学的总体发生率相似。对于传统涂片（12个月），在43289次涂片中诊断出46例（0.11%）。对于薄层液基细胞学检测（6个月），在25783张载玻片中诊断出36例（0.14%，P = 无统计学差异）。1997年，传统涂片经活检确诊为原位腺癌（AIS）或腺癌的有9例，而1998年6个月的薄层液基细胞学检测方法有10例。使用薄层液基腺性细胞学检测发现，非腺性（鳞状）活检诊断的杂项数量有统计学意义的减少（14例对4例，P <.05）。对于已知经活检确诊为AIS或腺癌的腺性病例，使用薄层液基细胞学检测方法发现细胞学假阴性率有统计学意义的降低（17例对4例，P <.02）。
薄层液基细胞学检测方法能更准确地诊断腺性疾病，对腺性病变的敏感性和特异性均有所提高。
