宫颈液基细胞学检查中非典型腺细胞的临床病理学意义  

Clinicopathological significance of atypical glandular cells in cervical liquid-based cytology test

作　　者：刘璐 陈汝蕾 王凤[1] 吕京澴[1] LIU Lu;CHEN Rulei;WANG Feng;LÜJinghuan(Department of Pathology,Suzhou Municipal Hospital/Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Jiangsu 215000,China)

机构地区：[1]苏州市立医院集团/南京医科大学附属苏州医院病理科,江苏苏州215000

出　　处：《临床与病理杂志》2024年第11期1534-1542,共9页Journal of Clinical and Pathological Research

摘　　要：目的:随着宫颈筛查的普及,宫颈腺癌的发病率不降反升。本研究对宫颈液基细胞学检查(thinprep cytology test,TCT)中非典型腺细胞(atypical glandular cell,AGC)进行分析,并探讨其临床意义。方法:收集87例AGC患者,并进行病理组织学诊断、人乳头瘤病毒(human papilloma virus,HPV)检测,探讨AGC与组织学诊断、HPV感染等临床病理学特征之间的关系。结果:AGC患者87例,其中非典型腺细胞-非特指型(atypical glandular cell,nototherwise specified,AGC-NOS)患者23例(26.4%),非典型子宫颈管细胞(atypical endocervical cell,AEC)患者28例(32.2%),非典型子宫内膜细胞(atypical endometrial cell,AMC)患者13例(14.9%),非典型腺细胞-倾向肿瘤(atypical glandular cells,favor neoplastic,AGC-FN)患者23例(26.4%)。经组织学诊断,其中良性病变19例(21.8%),上皮内病变34例(39.1%),恶性病变34例(39.1%)。病变范围涉及宫颈、内膜、卵巢及宫颈转移癌(胃肠道来源)。对液基细胞片进行细胞周期素依赖性激酶抑制剂2A(cyclin-dependent kinase inhibitor 2A,p16)、细胞增殖指数Ki-67免疫组织化学染色有助于AGC的诊断。宫颈病变患者与HPV感染的相关性高于内膜病变患者(P<0.01)。≥40岁患者宫颈腺上皮病变的比例高于宫颈鳞状上皮病变患者(P<0.05)。≥40岁患者内膜病变的比例明显高于宫颈病变患者(P<0.01)。AGC患者中浸润性病变多数处于病变I、II期(79.3%)。结论:AGC是提示宫颈上皮病变及内膜病变的重要指标,结合HPV检测、免疫组织化学标志及患者年龄等对临床诊断有重要的指导作用。Objective:Despite the widespread adoption of cervical screening,the incidence of cervical adenocarcinoma continues to rise.This study aims to analyze atypical glandular cells(AGC)detected in thinprep cytology tests(TCT)and explore their clinical significance.Methods:A total of 87 AGC cases were collected for histopathological diagnosis and human papilloma virus(HPV)testing to investigate the relationship between AGC and histological diagnoses,HPV infection,and other clinicopathological characteristics.Results:Among the 87 AGC cases,23 cases(26.44%)were classified as atypical glandular cells-not otherwise specified(AGC-NOS),28 cases(32.18%)as atypical endocervical cells(AEC),13 cases(14.94%)as atypical endometrial cells(AMC),and 23 cases(26.44%)as atypical glandular cells-favor neoplastic(AGC-FN).Histopathological diagnosis revealed 19 cases(21.8%)of benign lesions,34 cases(39.1%)of epithelial intraepithelial lesions,and 34 cases(39.1%)of malignant lesions.The lesions involved the cervix,endometrium,ovary,and metastatic cervical adenocarcinoma of gastrointestinal origin.Immunohistochemical staining of liquid-based cytology slides for cyclin-dependent kinase inhibitor 2 A(p 16)and Ki-67 cell proliferation index was helpful in AGC diagnosis.Cervical lesions were more strongly associated with HPV infection than endometrial lesions(P<0.01).Patients aged≥40 years had a higher prevalence of cervical glandular epithelial lesions than squamous epithelial lesions(P<0.05).Additionally,endometrial lesions were significantly more common than cervical lesions in patients aged≥40 years(P<0.01).Most invasive lesions in AGC cases were diagnosed at stage I or II(79.3%).Conclusion:AGC is an important indicator for cervical epithelial and endometrial lesions.The combination of HPV testing,immunohistochemical markers,and patient age provides valuable guidance for clinical diagnosis.

关 键 词：宫颈病变 宫颈液基细胞学检查 非典型腺细胞 人乳头瘤病毒 宫颈腺癌 

分 类 号：R73[医药卫生—肿瘤]