细胞学筛查中非典型腺细胞的临床意义  

Clinical significance of atypical glandular cells in cytologic screening

作　　者：王成[1] 涂琴[2] 李志英 WANG Cheng;TU Qin;LI Zhiying(Department of Pathology,Jiujiang Maternal and Child Health Hospital,Jiangxi,Jiujiang 332000,China;Department of Gynecology,Jiujiang Maternal and Child Health Hospital,Jiangxi,Jiujiang 332000,China;Department of Obstetrics and Gynecology,Jiujiang Maternal and Child Health Hospital,Jiangxi,Jiujiang 332000,China)

机构地区：[1]江西省九江市妇幼保健院病理科,江西九江332000 [2]江西省九江市妇幼保健院妇科,江西九江332000 [3]江西省九江市妇幼保健院妇产科,江西九江332000

出　　处：《中国医药科学》2022年第15期167-170,189,共5页China Medicine And Pharmacy

基　　金：江西省九江市科学技术局立项课题(九科字[2021]30号-47)。

摘　　要：目的 探讨新柏氏薄层液基细胞学(TCT)检查结果为非典型腺细胞(AGC)的临床病理意义。方法对2016年1月至2021年10月九江市妇幼保健院妇科TCT检查诊断为AGC的204例患者的组织病理学结果进行回顾性分析,以宫颈高级别鳞状上皮内病变(HSIL)、宫颈腺上皮不典型增生、子宫内膜非典型增生及以上病例为组织学阳性病例,分析患者年龄、HPV结果与病变的关系。结果 AGC的检出率0.13%(207/154 990)。43例AGC-FN中阳性病例29例(67.44%),137例AGC-NOS中阳性病例36例(26.28%),差异有统计学意义(χ^(2)=24.038,P=0.000)。>40岁组阳性病例检出率(42.07%,61/145)高于≤40岁组(11.43%,4/35),差异有统计学意义(χ^(2)=11.473,P=0.001)。宫颈病变患者的hr-HPV阳性率(58.33%,14/24)高于子宫内膜病变患者(38.89%,7/18),差异无统计学意义(χ^(2)=1.556,P=0.212)。有HPV结果的16例宫颈腺上皮病变患者中,8例hr-HPV阳性、8例hr-HPV阴性。结论 细胞学医师阅片时将AGC细分为AGC-NOS和AGC-FN是必要的,年龄对AGC患者的管理有一定参考价值,无论HPV结果如何,临床医师均需重视AGC患者的随访。Objective To investigate the clinicopathological significance of atypical glandular cells(AGC) as a result of Thinprep cytologic test(TCT). Methods The histopathological results of 204 patients diagnosed with AGC by TCT in the Department of Gynecology of Jiujiang Maternal and Child Health Hospital from January 2016to October 2021 were retrospectively analyzed. The relationship among patient age, HPV results and lesions were analyzed with high-grade squamous intraepithelial lesions(HSIL), atypical cervical glandular epithelial hyperplasia, atypical endometrial hyperplasia and above cases as histologically positive cases. Results The detection rate of AGC was 0.13%(207/154 990). There were 29 positive cases(67.44%) in 43 cases of AGC-FN and 36 positive cases(26.28%) in 137 cases of AGC-NOS, with statistically significant differences(χ^(2)=24.038, P=0.000).The detection rate of positive cases in the >40 years group(42.07%, 61/145) was higher than that in the ≤ 40 years group(11.43%, 4/35), with statistically significant differences(χ^(2)=11.473, P=0.001). The positivity rate of high-risk human papillomavirus(hrHPV) in patients with cervical lesions(58.33%,14/24) was higher than that in patients with endometrial lesions(38.89%, 7/18), with no statistically significant difference(χ^(2)=1.556, P=0.212). Of the 16 patients with cervical glandular epithelial lesions with HPV results, 8 were hr-HPV positive and 8 were hr-HPV negative.Conclusion It is necessary for cytologists to subdivide the AGC into AGC-NOS and AGC-FN when reading the films, and to take into account age in the management of AGC patients. In addition, clinicians should pay attention to the follow-up of AGC patients regardless of HPV results.

关 键 词：非典型腺细胞 高危型人乳头瘤病毒 年龄 病理学 

分 类 号：R737.33[医药卫生—肿瘤]