宫颈细胞学筛查结果中非典型腺细胞的临床意义  

Clinical significance on atypical glandular cells incervical cytology screening results

作　　者：王彩红[1] 赵文英[1] 潘晋兵[1] 李赟[1] 

机构地区：[1]山西省妇幼保健院,山西太原030013

出　　处：《临床医药实践》2015年第5期334-337,共4页Proceeding of Clinical Medicine

摘　　要：目的：探讨宫颈细胞学筛查结果中不典型腺上皮细胞（AGC）的临床意义。方法：选择经液基细胞学（LCT）检查诊断AGC患者109例,分析其阴道镜检查、活组织检查、子宫分段诊刮、子宫颈电热圈环切术（LEEP）的组织病理诊断及HR-HPV DNA检测的结果及其临床意义。结果：AGC检出率为0.26%（109/41 328）;109例AGC中病理异常61例（55.96%）：鳞状上皮病变41例和腺上皮异常20例。88例AGC非特异类型中组织学结果异常42例（47.73%）;15例AGC倾向上皮内瘤变中病理异常13例（86.67%）;6例原位腺癌（AIS）/腺癌中发现浸润癌5例及宫颈原位腺癌伴CINⅢ1例。AGC倾向上皮内瘤变组和原位腺癌（AIS）/腺癌组的患病率均明显高于AGC非特异类型组,差异有统计学意义（P〈0.05）。109例AGC行HR-HPV DNA检测,阳性41例（37.61%）,在宫颈上皮高度病变及宫颈癌中,其敏感性为90.24%,特异性为92.68%,阳性预测值为92.50%,阴性预测值为88.37%。109例AGC患者中,年龄〈40岁者46例中病理学结果异常28例,年龄40~68岁的63例中病理学结果异常33例,两个年龄段的患病率比较,差异无统计学意义（P〉0.05）。结论：AGC是一个重要的细胞学诊断提示,与宫颈和子宫内膜病变密切相关,应行HR-HPV检测以及阴道镜指引下活组织检查术、分段诊刮术和宫颈环形电切（LEEP）术或锥切术,以便早期发现宫颈及子宫内膜癌前病变或癌。Objective：To determine clinical implications of atypical glandular cells（AGC）in cervical cytological results. Methods：All 109 cases of cervical cytological examinations（LCT）with AGC were identified. The histopathological results of cervix were analyzed by colposcopic biopsy,dilatation and curettage,cervical loop electrosurgical excision procedure（LEEP） andhigh - risk human papilloma virus DNA testing . Results ：Detectable rate of AGC was0 . 2 6 %（ 1 0 9 / 4 1 3 2 8 ）. 6 1 cases （55. 96% ）had pathologic lesions：41 squamous lesion and 20 glandular lesions. Among 88 patients as AGC - not otherwise specified,there were 42 pathological abnormalities. 15 patients with AGC as favor intraepithelial neoplasis were of 13 pathologi-cal abnormalities. 6 patients with AGC as adenocarcinoma in situ or adenocarcinoma were of six pathological abnormalities. 5 cases of invasive cancer and 1 case of adenocarcinoma in situ with CINⅢ. The illness frequency rate AGC tendency intraepi-thelial neoplasia group and adenocarcinoma in situ（AIS）/ adenocarcinoma group was significantly higher than that of non -specific type AGC group,the difference was statistically significant（P 〈 0. 05）. All of human papilloma virus testing,41 cases were abnormal（37. 61% ）. In predicting the presence of high - grade of cervical intraepithelial neoplasia,the sensitivity of hu-man papilloma virus was 9 0 . 2 4 % ,specificity 9 2 . 6 8 % ,positive predictive value 9 2 . 5 0 % and negative predictive value 88. 37% . 28 women of younger than 40 years old had pathologic lesions,33 women of aged over 40 ~ 68 years old had patholog-ic lesions. The prevalence of the two age groups,the difference was not statistically significant P 〉 0. 05. Conclusion：AGC was closely related to cervical and endometrial lesions. in order to early discovery cervical and endometrial lesions,AGC patients should be given HPV DNA test,colposcopic examination and biopsy,dilatation and curettage,LEEP,onization of cervix.

关 键 词：液基细胞学(LCT) 不典型腺上皮细胞(AGC) 组织病理学 人乳头瘤病毒 宫颈上皮内瘤变 

分 类 号：R737.33[医药卫生—肿瘤]