非典型腺细胞在宫颈细胞学筛查中的临床意义  

Clinical significance of atypical glandular cells in cervical cytology screening

作　　者：李栋连 孙春杰 张云岗[2] LI Dong-lian;SUN Chun-jie;ZHANG Yun-gang(Department of Pathology,First Affiliated Tongzhou District Maternity and Child Care Hospital,Beijing 10020,China;Department of Pathology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 10020,China)

机构地区：[1]北京市通州区妇幼保健院病理科,北京101100 [2]首都医科大学附属北京朝阳医院病理科,北京100020

出　　处：《诊断病理学杂志》2024年第12期1150-1154,1159,共6页Chinese Journal of Diagnostic Pathology

摘　　要：目的 分析非典型腺细胞(AGC)和高危人乳头状瘤病毒(HR-HPV)感染及组织学的关系,探讨AGC诊断的临床价值。方法 我们对2017年2月至2022年1月诊断为AGC的50位患者的宫颈组织学、子宫内膜组织学及HR-HPV检测结果进行回顾性分析。采用卡方检验分析各年龄组患有鳞状上皮病变和腺上皮病变患者的HPV检出率。结果 AGC的检出率为0.04%(50/116598)。在50位AGC患者中有35例获得有效随访,其中年龄>40岁组的子宫内膜病变检出率(30.4%,7/23)明显高于≤40岁组(0,0/11)的检出率,差异有统计学意义(P<0.01)。年龄≤40岁组的宫颈病变检出率(7/12,58.3%)明显高于年龄>40岁组的检出率(4/23,35.8%),差异有统计学意义(P<0.05)。此外,宫颈上皮内病变的HR-HPV阳性率(5/9,55.6%)明显高于子宫内膜病变(1/6,16.7%),差异有统计学意义(P<0.01)。结论 虽然AGC检出率较低,但其与多种癌症及癌前病变密切相关。AGC结合患者年龄以及HPV检测对临床诊断具有非常重要的指导意义。Objective To explore the clinical application value and management of atypical glandular cells(AGC) diagnosis by analyzing the histology and HR-HPV test results of cervical cytology screening for AGC.Methods The cervical and endometrial histological results and HR-HPV test results of 50 AGC patients from February 2017 to January 2022 were retrospectively analyzed.Histologic specimens were obtained by cervical biopsy,cervical canal curettage,cervical conization,segmented diagnostic curettage,and hysterectomy specimens,and the HPV detection rate of patients with squamous cell and adenoepithelial lesions in all age groups was analyzed by chi-square test.Results The detection rate of AGC was 0.04%(50/116598).A total of 35 cases were effectively followed up in the50 cases of AGC.The detection endometrial lesionsrate of age >40 years(34.4%,8/23) was higher than age ≤40 years(0,0/17),and the difference was statistically significant(P < 0.01).The detection rate of HSIL + in the age ≤40 years group(7/12,58.3%) was significantly higher than age >40 years(4/23,35.8%),and the difference was statistically significant(P < 0.05).In addition,the positive rate of HR-HPV in cervical epithelial lesions was significantly higher than that in glandular epithelial lesions(P < 0.001).Conclusion The detection rate of AGC is low,but it is closely related to a variety cancers and precancerous lesions.AGC combined with patient ages as well as HPV testing can play a very important role in clinical diagnosis.

关 键 词：非典型腺细胞 宫颈细胞学 高危人乳头状瘤 临床诊断 检出率 

分 类 号：R737.33[医药卫生—肿瘤]