子宫颈液基细胞学诊断非典型腺细胞的临床意义  

Clinical significance of cervical liquid-based cytology in diagnosis of atypical glandular cells

作　　者：李琦 于晓红[1] 杨亮亮[1] 骆萍 LI Qi;YU Xiao-hong;YANG Liang-liang;LUO Ping(Department of Pathology,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,China;Department of Oncology Surgery,the Third Hospital of Nanchang,Nanchang 330009,China)

机构地区：[1]江西省妇幼保健院病理科,南昌330006 [2]江西省南昌市第三医院肿瘤外科,南昌330009

出　　处：《临床与实验病理学杂志》2019年第11期1281-1285,共5页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨子宫颈细胞学诊断非典型腺细胞(atypical glandular cells,AGC)的临床意义。方法分析细胞学诊断为AGC病例的组织病理学结果,对细胞学诊断的准确性进行评估,并分析病变与患者年龄、高危HPV感染的关系。结果AGC的发生率为0.120%(494/412010),494例AGC中450例有病理诊断结果。450例AGC中良性128例(28.4%),病理结果异常(不典型增生及以上)322例(71.6%):子宫颈鳞状上皮病变48例(14.9%)(低级别鳞状上皮内病变6例,高级别鳞状上皮内病变30例,鳞癌12例);子宫颈腺上皮病变166例(51.6%)(子宫颈腺体不典型增生6例,子宫颈原位腺癌29例,子宫颈腺癌131例);子宫内膜病变108例(33.5%)(内膜不典型增生2例,子宫内膜腺癌104例,肉瘤2例)。年龄<35岁组与良性/反应性和子宫颈病变有关;年龄35~50岁组子宫颈腺上皮病变高发,绝大多数的子宫颈原位腺癌(22/29)和大多数的子宫颈腺癌(74/131)在此年龄组中被发现;年龄>50岁组子宫内膜病变最常见,且侵袭性子宫颈癌和子宫内膜癌检出率最高(P<0.05)。306例AGC行高危HPV-DNA检测,阳性140例(45.8%)。子宫颈鳞状上皮病变、子宫颈腺上皮病变、子宫内膜病变HPV阳性率分别为82.5%、68.9%、7.7%,高危HPV阳性和细胞学诊断为AGC可以显著增加子宫颈病变的检出率(P<0.001)。结论AGC的诊断对子宫颈和子宫内膜腺上皮病变具有重要的提示作用,年龄和高危HPV感染的情况对AGC患者的随访和管理具有重要参考意义。Purpose To explore the clinical significance of the cervical cytologic diagnosis of atypical glandular cells(AGC).Methods The histopathological results of cytological diagnosis of AGC were analyzed.The accuracy of cytological diagnosis was evaluated and the relationship between lesions and age,high-risk human papilloma virus infection was analyzed.Results The incidence of AGC was 0.120%(494/412010),and 450 cases were diagnosed by histopathology.In the 450 cases of AGC,in which 128(28.4%)were benign,322(71.6%)were abnormal pathological findings(atypical hyperplasia and above):48(14.9%)cervical squamous lesions,6 low-grade squamous intraepithelial lesion(LSIL),30 high-grade squamous intraepithelial lesion(HSIL),and 12 squamous cell carcinoma(SCC).There were 166(51.6%)cervical glandular lesions(6 cervical glandular atypical hyperplasia,29 cervical adenocarcinoma in situ and 131 cervical adenocarcinoma)and 108(33.5%)endometrial lesions(2 endometrial atypical hyperplasia,104 endometrial adenocarcinoma,2 sarcoma).The women<35 years old were associated with benign/reactive and cervical lesions,and 35~50 years old women had high incidence of cervical glandular lesions;the vast majority of AIS(22/29)and most cervical adenocarcinoma(74/131)were found in this group.The endometrial lesions were most commonly found in the women>50 years old,and the rate of invasive cervical cancer and endometrial cancer was the highest(P<0.05).306 AGC cases underwent high-risk HPV-DNA testing,and 140(45.8%)were positive.The HPV positive rates of cervical squamous lesions,cervical glandular lesions,and endometrial lesions were 82.5%,68.9%,and 7.7%,respectively.High-risk HPV positive and cytological diagnosis of AGC significantly increased the detection rate of cervical lesions(P<0.001).Conclusion The diagnosis of AGC plays an important role in the detection of cervical and endometrial glandular epithelial lesions.Age and high-risk HPV infection have important reference significance for the follow-up and management of AGC patients.

关 键 词：子宫颈细胞学 非典型腺细胞 年龄 高危HPV 病理学 

分 类 号：R446[医药卫生—诊断学]