ThinPrep液基细胞学在宫颈病变上的临床应用

目的 评价ThinPrep液基细胞学在筛查宫颈病变的临床应用价值。方法 ThinPrep液基细胞学检测了1036例妇科病例,同时做宫颈巴氏涂片检测。细胞学诊断采用TBS分级系统,阳性诊断包括意义不明的非典型鳞状上皮细胞(atypicalsquamous cells of undetermined significance,ASCUS)以上的病变,诊断结果与阴道镜下多点组织活检病理结果相对照。结果 Thi-nPrep液基细胞学检出100％(4/4)的鳞状细胞癌(SCC);96.97％(32/33)的鳞状上皮内高度病变(HSIL)及89.71％(61/68)的低度鳞状上皮内病变(LSIL)。ThinPrep液基细胞学的敏感性与阳性预测值分别为97.32％、83.89％,且显著降低了标本的不满意率。结论 ThinPrep液基细胞学检查敏感性高,标本质量高,利于宫颈病变的早期诊断。     

液基细胞学在子宫颈病变筛查中的诊断价值

目的评价液基细胞学在宫颈癌前病变早期诊断中的价值。方法采用贝塞斯达（TBS）诊断系统对3227例经宫颈／阴道液基薄层细胞学检查（TCT）的标本进行分析，部分病例经组织学对比印证。结果不典型鳞状细胞（ASCUS）以上异常228例（7．1％）：ASCUS 119例（3．69％），低度上皮内瘤变（L．SIL）79例（2．44％），高度上皮内瘤变（H-SIL）18例（0．56％），鳞癌（SCC）9例（0．28％），不典型腺细胞（AGUS）3例（0．09％）。其中66例细胞异常者行病理活检，CIN2以上病变两种检测方法的符合率为92．6％（25／27）。结论液基细胞学检查为一种准确、简便的宫颈早期病变筛查方法．可作为宫颈癌防治的有效工具。     

9012例子宫颈液基细胞学诊断结果分析

目的探讨液基薄层细胞(TCT)检查在宫颈癌及癌前病变筛查中的应用价值。方法回顾分析开县人民医院9 012例宫颈液基细胞学检测结果和伯塞斯达系统(TBS)分类系统结果,其中12例ASC-US、10例ASC-H、35例低度鳞状上皮内病变(LSIL)、72例高度鳞状上皮内病变(HSIL)、2例鳞状上皮细胞癌(SCC)和6例腺细胞异常做阴道镜下病理活检,对细胞学异常结果与阴道镜下活组织检查病理诊断结果进行比较。结果 9 012例液基细胞学检测中,筛查出非典型鳞状细胞(ASC-US)以上病例285例,阳性率3.2%。液基细胞学检测与阴道镜下病理活检结果的符合率为91.24%。结论 TCT制片技术和TBS报告能较全面反映宫颈病变的情况,通过定期正规的筛查,能早期发现宫颈癌及癌前病变,从而早期治疗,阻止病变升级是预防宫颈癌的关键。     

液基细胞学联合阴道镜检查在诊断子宫颈病变中的临床应用

目的提高子宫颈病变的诊断。方法行液基细胞学（TCT）检查2425例，对其中272例细胞学阳性病例行阴道镜检查及镜下活组织病理检查。结果行TCT检查2425例，细胞学阳性272例，占11．22％，其中非典型鳞状细胞（ASC）122例占5、03％；非典型腺细胞（AGUS）31例占1．28％；宫颈上皮内瘤样病变（CIN）110例，占4．54％，鳞癌（CA）9例，占0．37％。对所有细胞学阳性病例均行阴道镜检查及镜下活组织病理检查。异常阴道镜图像251例，占92．28％。病理检查结果为慢性宫颈炎21例：宫颈上皮内瘤变242例，其中CINⅠ112例，CINⅡ85例，CINⅠⅢ45例；宫颈鳞癌9例。结论应用TCT筛查子宫颈病变，细胞学阳性病例联合阴道镜检查及镜下活组织病理检查，能早期发现癌前病变，防治宫颈癌。     

人乳头瘤病毒检测在宫颈病变中的应用价值

目的了解宫颈细胞学异常患者中人乳头瘤“毒（HPV）的感染状况,评估HPV检测在宫颈病变筛查中的价值。方法随机选取宫颈薄层液基细胞学检测异常的101例患者进行了HPV检测,同时行组织病理学检查。结果（1）101例宫颈细胞学异常患者中,细胞学为ASCUS、LSIL、HSIL、鳞状细胞癌时高危型HPV阳性率分别为84．2％、88．6％、100．0％和2／2;（2）10l例细胞学异常患者中20例为CINI,81例为CINⅡ及以上级别,高危型HPV阳性率存CINI、CINⅡ及以上级别分别为60％、97．5％;（3）ASCUS组中,高危型HPV阳性患者中CINⅡ及以上病变的发生率为87．5％,HPV阴性患者中CINⅡ及以上病变的发生率为16．7％;（4）高危型HPV型别分布由高到低分别为HPVl6型39．6％（40／101）,HPV58型17．8％（18／101）,HPV52型16．8％（17／101）,HPVl8型9．9％（10／101）以及HPV33型9．9％（10／101）。结论高危型HPV感染率与宫颈病变级别呈正相关;HPV检测可作为ASCUS患者的有效分流手段。宫颈病变患者中高危型HPV感染以16、58、52、18、33型为主。     

宫颈脱落细胞miR-125b与宫颈病变关系及其在HR-HPV 阳性患者分层筛查中的作用研究

比较正常宫颈、宫颈上皮内瘤变及宫颈癌患者宫颈脱落细胞中miR-125b表达水平差异,探讨宫颈脱落细胞miR-125b表达水平检测在HR-HPV阳性患者分层筛查中的作用及其与宫颈病变的关系。方法 采用第二代杂交捕获技术进行HR-HPV初筛,HR-HPV阳性患者行宫颈液基薄层细胞学检查及miR-125b检测。液基细胞学检查结果异常者直接阴道镜下活检行病理学检查,液基细胞学检查正常者行阴道镜检查,阴道镜检查下发现异常者行阴道镜下活检取材,余视作宫颈组织学正常,不做宫颈活检。RT-qPCR检测正常宫颈及不同级别宫颈病变中miR-125b表达水平,比较不同组织学分组之间的宫颈脱落细胞miR-125b表达水平,绘制ROC曲线,探讨miR-125b、液基细胞学检查在宫颈病变中的诊断作用。结果 宫颈脱落细胞miR-125b水平随着宫颈病变程度加重逐渐升高（P＜0.05）;在HR-HPV阳性患者分层筛查中,宫颈液基细胞学诊断宫颈高级别上皮内病变的敏感性、特异性分别为64.90%、80.70%,AUC为0.728（95%CI:0.657~0.779,P＜0.001）。与液基细胞学检查相比,宫颈脱落细胞miR-125b检测诊断宫颈高级别上皮内病变的灵敏性、特异性更高（87.30% vs 64.90%;69.20% vs 80.70%）,AUC为 0.864（95%CI:0.800~0.928,P＜0.001）。结论 miR-125b水平随着宫颈病变加重逐渐升高,检测宫颈脱落细胞miR-125b水平可有效分流HR-HPV阳性患者,敏感性高于细胞学检查,可能成为一种有效的分层筛查方法。     

宫颈细胞学ASCUS/LSIL的临床意义及处理

目的探讨宫颈不典型鳞状上皮，低度鳞状上皮内病变（ASCUS／LSIL）的临床意义及处理方法。方法对中国医学科学院肿瘤医院2004～2006年妇科门诊用TCT（宫颈液基细胞学）的方法检出的254例ASCUS／LSIL以病理结果为金标准进行回顾性分析，其中136例进行了阴道镜检查。结果在140例ASCUS中，宫颈上皮内瘤变（CIN）病变占51．5％，其中高度病变占22．9％，114例LSIL中CIN病变占59．6％，其中高度病变占30．7％，两组资料比较差异无统计学意义，P〉0．05。其中136例中阴道镜诊断炎症47例，低度宫颈上皮内病变53例，高度宫颈上皮内病变36例及病理检查结果炎症55例，低度宫颈上皮内病变41例，高度宫颈上皮内病变40例，阴道镜与病理对照进行了～致性检验，Kappa=0．314，U=0．064，P〈0．05，一致性好。病理证实人乳头状瘤病毒（HPV）阳性的妇女中CIN发生率79％（67／84），而HPV阴性者中CIN发生率43．5％％（74／170），结果显示两组资料比较差异有统计学意义，X^2=29．88，P〈0．05。本组资料中年龄在35～55岁的妇女占83．5％与HPV阳性的妇女年龄高峰一致。结论对ASCUS的患者应与LSIL同样重视，立即进行阴道镜检查以避免22．9％的高度病变的患者漏诊或失访，对35～55岁的HPV感染的妇女应更加重视。     

液基薄层细胞学检测及TBS分类在宫颈病变诊断中的应用

目的探讨液基薄层细胞学（TCT）检测在宫颈病变诊断中的价值。方法对648例宫颈异常的患者进行液基薄层细胞学检测，将诊断意义不明的不典型细胞（ASCUS）以上病变者行阴道镜下活检，将细胞学检测结果与活检结果作对比分析。结果648例TCT检测的患者中，宫颈病变发生率达81．9％，其中良性病变348例，占53．7％，宫颈上皮内病变183例，占28．2％，对183例异常者进行阴道镜下活检与组织病理学诊断比较，符合率为83．6％。宫颈上皮内病变高发年龄为30～40岁，占37．8％。结论TCT技术在宫颈病变的诊断中，具有简便、实用，准确率高的特点，配合阴道镜检查能及时发现宫颈早期病变，是防止宫颈癌的关键。     

宫颈鳞状细胞癌癌前病变分类系统的进展和争议

宫颈鳞状细胞癌癌前病变的分类系统包括异型增生／原位癌和宫颈上皮内肿瘤（CIN）系统,近年CIN在分CINⅠ、Ⅱ、Ⅲ3个级别的基础上又增加了意义不能确定的基底细胞异常（BAUS）和CIN（无法定级别）等范畴。随着宫颈细胞学TBS系统的推广,在有的国家出现了以两级别的鳞状上皮内病变（SIL）取代CIN分级的趋势。赞成使用两级分类系统的学者认为,严格区分CIN和湿疣有时比较困难,这些病变均为人乳头状瘤病毒（HPV）感染所致,其病变构成了一个谱系,应将它们包括在一个以形态学分类为主的系统中,尤其是在活检中使用两级别分类法,可使组织病理学与细胞学诊断保持一致,有利于临床医师处理。反对使用两级分类系统的学者则认为,将CINⅡ和CINⅡ合并为高级别病变并不为生物学行为和HPV型别所支持,且可能导致治疗过度。随着基因组和蛋白质组研究的进展,新的诊断指标已现端倪,目前应维持已被广泛接受的三级分级系统。当前宫颈鳞状细胞癌癌前病变的分类系统有异型增生／原位癌、CIN和SIL3个系统,SIL在有的国家已大量使用,然而对是否以此取代CIN争议极大。     

宫颈液基超薄细胞学检查临床应用价值探讨

目的 探讨宫颈液基超薄细胞学检查(Thinp rep cytologic,TOT)和Bethesda系统(TBS)在宫颈病变诊断中的临床价值.方法 对3146例本院宫颈疾病就诊者行TCT检查和TBS细胞学分类诊断,对TCT检查异常者进行阴道镜病理检查.结果 异常涂片208例(占6.61%),其中不典型鳞状细胞(ASC)68例(2.19%),低度鳞状上皮内瘤变(LSIL)95例(3.02%)高度鳞状上皮内瘤变(HSIL)41例(1.31%).鳞状细胞癌(SCC)4例(0.12%).异常细胞涂片30-39岁80例(38.1%),40-49岁55例(26.12%),与其他年龄组比较差异有统计学意义(P<0.05).TCT检查与病理检查符合率分别为LSIL81%,HSIL92%,SCC100%,两者比较差异无统计学意义.结论 TCT结合TBS应用于宫颈细胞涂片配合阴道镜活检,是筛查和诊断宫颈癌前病变的可靠手段.     

Clinical role of p16INK4a expression in liquid-based cervical cytology: correlation with HPV testing and histologic diagnosis

p16INK4a is overexpressed in high-risk human papillomavirus (HR-HPV)-infected preneoplastic and neoplastic lesions of the uterine cervix. Our aim was to verify whether p16 is a diagnostic marker also in cervical liquid-based cytology. We performed p16 immunocytochemical analysis and the Hybrid Capture 2 (HC2) test (Digene, Gaithersburg, MD) for HR-HPV infection in 471 ThinPrep-processed (Cytyc, Boxborough, MA) cervicovaginal samples and correlated the results with histologic findings. A total of 32.3% of the specimens showed p16 immunoreactivity, whereas the HC2 test was positive in 41.2% of the cases (65.2% concordance rate). Correlating the cytologic, p16, and HPV results with histologic findings revealed HC2 as the most sensitive test for a diagnosis of cervical intraepithelial neoplasia 2 or worse, whereas cytologic examination was the most specific. The positive predictive value was significantly higher for cytologic examination than for p16 and HR-HPV testing. These data suggest that p16 evaluation in ThinPrep samples does not have better clinical effectiveness for identifying high-grade lesions than conventional morphologic examination and HPV testing.     

"Low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion" is a distinct cytologic category: histologic outcomes and HPV prevalence

We examined the histologic outcomes and prevalence of high-risk human papillomavirus (HR-HPV) in women with liquid-based Papanicolaou (Pap) tests interpreted as "low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion" (LSIL-H) compared with the 2001 Bethesda System (TBS 2001) cytologic categories of LSIL, high-grade SIL (HSIL), and atypical squamous cells, cannot exclude HSIL (ASC-H). A computer search identified 426 LSIL, 86 ASC-H, 81 LSIL-H, and 110 HSIL cytologic interpretations during a 1-year period, each with up to 2 years of histologic follow-up. The risk of histologic cervical intraepithelial neoplasia (CIN) 2 or worse (CIN 2+) associated with LSIL-H (32/81 [40%]) was intermediate between LSIL (46/426 [10.8%]) and HSIL (72/110 [65.5%]), but not significantly different from ASC-H (23/86 [27%]). However, LSIL-H was more frequently associated with a definitive histologic diagnosis of any CIN (CIN 1+) than ASC-H (53/81 [65%] vs 35/86 [41%]). Moreover, the prevalence of HR-HPV was significantly greater in patients with LSIL-H than in patients with ASC-H (15/15 [100%] vs 43/73 [59%]). The histologic outcomes and HR-HPV prevalence associated with LSIL-H differ significantly from the established categories of TBS 2001 and provide evidence to support the recognition of LSIL-H as a distinct cytologic category.     

The clinician's view: role of human papillomavirus testing in the American Society for Colposcopy and Cervical Pathology Guidelines for the management of abnormal cervical cytology and cervical cancer precursors

The American Society for Colposcopy and Cervical Pathology (ASCCP) National Consensus Conference for the Management of Women With Cervical Cytological Abnormalities and Cervical Cancer Precursors was held on the National Institutes of Health campus in Bethesda, Md, September 6-8, 2001. The conference was attended by 121 representatives from 29 national organizations interested in cervical cancer screening issues. For the first time, guidelines for the management of women with abnormal cervical cytology, developed from evidence-based literature, were presented to delegates from the majority of organizations with interest in cervical cancer screening, voted on, and revised when necessary to achieve a majority two-thirds approval. This development of consensus-approved guidelines is likely to be considered one of the most important milestones to date in the management of women with abnormal cervical cytology. The timing of this Consensus Conference resulted from the convergence of many different factors, including new cytologic terminology developed at the Bethesda 2001 workshop and publication of the enrollment data from the National Cancer Institute's Atypical Squamous Cells of Undetermined Significance (ASC-US)/Low-Grade Squamous Intraepithelial Lesions (LSIL) Triage Study, otherwise known as ALTS. Additionally, new preliminary longitudinal ALTS data provided much of the information on the natural history of abnormal Papanicolaou tests and cervical intraepithelial neoplasia (CIN), as well as data on the performance of both new liquid-based cytology and human papillomavirus (HPV) DNA testing in the management of women following colposcopy. The result was a large database of new information that provided the foundation for the ASCCP Consensus Conference. This article covers only the recommendations of the ASCCP Guidelines that were based in large part on the results of the ALTS trial. Therefore, the focus is on the management of women with equivocal (ASC-US) and low-grade (LSIL) cytologic abnormalities. Management of women with these cytologic abnormalities has been particularly problematic, because individually these women are at least risk for CIN 3 and cancer, yet their sheer numerical dominance ensures that they account for the majority of high-grade CIN detected in the United States in the follow-up of abnormal cervical cytology. Data from ALTS confirmed that women with ASC-US could be safely managed by any of the conventional approaches (repeat Papanicolaou test, immediate colposcopy, or HPV testing), but that the preferred management approach for women having an ASC-US report from liquid-based cytology was to assess the patient's risk by testing for HPV. Additionally, longitudinal ALTS data determined that repeat liquid-based cytology at 6 and 12 months and an HPV test at 12 months were nearly equivalent options in the follow-up of women referred for HPV-positive ASC or LSIL, yet not found to have CIN 2+ at initial colposcopy. Therefore, all follow-up recommendations for women with CIN 1 or lower postcolposcopy findings include these 2 options. The data and the recommendations for the management of ASC-US, ASC cannot exclude high-grade squamous intraepithelial lesion, and LSIL are discussed.     

人类乳头状瘤病毒分型检测在宫颈癌筛查中的临床研究

目的 探讨人类乳头状瘤病毒（human papillomavirus,HPV）基因分型检测在宫颈病变诊断中的临床应用价值.方法 选取2010年1月至2012年12月在北京大学第一医院妇产科就诊的1715例患者作为研究对象,所有患者均行宫颈脱落细胞学检查、HPV分型检测及阴道镜检查下行多点活检,并最终经组织病理学检查诊断为宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）.分析HPV分型检查在宫颈癌筛查诊断中临床应用价值.结果 1715例CIN患者HPV检出率排名前五位的依次是HPV16、58、52、33、31;CIN2＋（包括CIN2/CIN3/原位腺癌/宫颈癌,以下简称CIN2＋）患者中前五位依次是HPVI6、58、33、52、31;其中CIN2＋中细胞学未见上皮内病变细胞和恶性细胞（negative for intraepithelial lesion or malignancy,NILM）患者中,Logistic回归分析结果显示HPV16、33和18型阳性致CIN2＋风险性较大,回归系数OR分别为5.031（P=0.000）、2.375 （P=0.000）和1.598（P =0.027）.宫颈脱落细胞学为非典型鳞状上皮细胞（atypical squamous cells of undetermined significance,ASCUS）,伴随HPV16、58型阳性,发生CIN2＋风险性较大,回归系数OR分别为5.139（P=0.000）和2.096（P=0.025）.宫颈脱落细胞学为低度鳞状上皮内病变（low squamous intraepithelial lesion,LSIL）,伴随HPV16、33、52型CIN2＋风险性较大,回归系数OR分别为5.774（P =0.000）、3.368（P =0.000）和1.747（P=0.034）.结论 HPV分型检测在宫颈癌筛查中具有重要作用,是指导细胞学阴性、ASCUS和LSIL患者临床处理时的重要参考指标,尤其是当HPV16型阳性时.     

液基细胞学技术联合高危HPV-DNA检测对宫颈癌前病变的诊断效度

目的: 探讨液基细胞学检查技术(LCT)联合高危人乳头状瘤病毒DNA(HPV-DNA)检测诊断宫颈癌前病变的效度。方法: 对2007年12月~2010年12月来我院行体检的19~65岁的6 521名女性采用LCT进行宫颈癌的筛查,以及HPV分型基因芯片检测系统进行18种高危HPV基因亚型检测。对上述检测阳性者行阴道镜下宫颈活组织检查,对检测均阴性者依其意愿进行阴道镜下宫颈活组织检查。结果: LCT阳性(≥ASCUS)152例,HPV阳性86例,其中二者均为阳性的有42例,LCT和HPV均为阴性的有6 325例;LCT阳性的152例和HPV阳性的86例中病理活组织检查结果为阳性(≥CIN I)的分别有112例和68例,其中LCT和HPV均阳性的42例中病理活组织检查阳性的有34例。LCT和HPV均为阴性的6 325例中有2 000人自愿行病理检查,其中1人病理检查结果为阳性。LCT诊断宫颈癌前病变的灵敏度为76.19%,特异度为98.05%;HPV检测诊断宫颈癌前病变的灵敏度为46.26%,特异度为99.12%;两方法联合诊断(其中1项阳性即判定为患者)宫颈癌前病变的灵敏度为99.32%,特异度为99.61%。结论: 液基细胞检测技术和高危HPV-DNA检测的联合应用优于单项技术检测,对于宫颈癌前病变的筛检具有重要意义。     

Cytohistological correlation in patients with atypical glandular cells on Papanicolaou test in a Chilean population

The standard screening test for detecting cervical lesions and cancers is a Papanicolaou (Pap) smear. While squamous cell abnormalities remain the most common positive Pap test result, cytologic findings of glandular cell abnormalities have become more frequent in recent decades. The 2014 Bethesda System for reporting cervical cytology includes the classification “atypical glandular cells” (AGC). AGC have morphological abnormalities that fall outside the range of reactive changes, but are insufficient for a diagnosis of invasive adenocarcinoma. In several histologic follow‐up studies, most AGC cases were found to represent a benign condition. In the current study, we evaluate the significance of AGC cytology findings by analyzing the histologic follow‐up results of a large number of patients with AGC. Most patients with AGC in this study were found to have a significant lesion on follow‐up (63.9%), with negative histologic results in only 36.1% of patients. Among patients with significant lesions, the most common result was low‐grade squamous intraepithelial lesion (26.6%), followed by high‐grade squamous intraepithelial lesion (23.2%). This provides further evidence to support the Chilean Clinical Guidelines for Cervical Cancer, which recommends diagnostic follow‐up studies in all women with AGC to minimize the chance of undetected serious cervical disease.     

HPV-DNA与TCT联合检测在宫颈早期病变筛查中的相关性研究

目的 探讨新柏氏液基薄层细胞学(TCT)技术联合HPV- DNA检测在宫颈早期病变筛查中的相关性.方法 对2008年9月至2011年7月来我院妇科门诊就诊的375例HPV- DNA阳性患者行TCT检测,采取TBS报告方式,将TCT与HPV- DNA结果对进行照分析.结果 375例HPV- DNA阳性患者TCT检查者,结果良性反应性改变273例(72.8％),ASC阳性者84例(22.4％),LSIL阳性6例(1.6％),HSIL阳性12例(3.2％),HPV高危亚型感染率分别为69.23％、92.86％、100％、100％.结论 TCT联合HPV- DNA检测可提高宫颈早期病变的诊断率.     

Atypical squamous cells of undetermined significance: Correlative histologic and follow-up studies from an academic medical center

The diagnosis of ASCUS (atypical squamous cells of undetermined significance) was introduced in the 1988 Bethesda System for reporting cervical/vaginal cytologic findings. Outcome and appropriate management of patients with this diagnosis is not presently established. Criteria defining ASCUS are nuclear enlargement (2.5–3.0 times normal intermediate cell nucleus), mild nuclear hyperchromasia, smooth nuclear outlines with mild variation in nuclear size and shape, or else two, but not all three, cytologic criteria for human papilloma virus (HPV) cytopathic effect. All 668 cases reported as ASCUS from February 1992–December 1993 from our cytology laboratory were reviewed. These ASCUS cases represented 4.5% of all gynecologic cases diagnosed in that same time period. Of these, 284 (41%) had a subsequent colposcopic biopsy and/or endocervical curettage. The biopsied cases included 101 (36%) with condylomata, 38 (13%) with cervical intraepithelial neoplasia (CIN) I, 17 (6%) with CIN II, and 9 (3%) with CIN III. No cases of carcinoma were detected. Of patients with a cytologic diagnosis of ASCUS and subsequent cervical biopsy, 49% had low-grade cervical intraepithelial neoplasia (LGSIL), either condyloma or CIN I. Nine percent had high-grade cervical intraepithelial neoplasia, either CIN II or CIN III. These findings indicate that ASCUS defines cytologically a group of patients who may have either a concurrent or subsequent development of a squamous intraepithelial lesion (SIL). This forms a high-risk group. The management of cases with a cytologic diagnosis of ASCUS should be at least as aggressive as that of LGSIL. Diagn. Cytopathol. 16:1–7, 1997. © 1997 Wiley-Liss, Inc.     

A follow-up study of atypical squamous cells in gynecologic cytology using conventional papanicolaou smears and liquid-based preparations: the impact of the Bethesda System 2001

We evaluated the impact of the Bethesda System (TBS) 2001 in cytology reporting of atypical squamous cells (ASC) when using conventional Pap smears and liquid-based cytology preparations (LBC). Follow-up information for all ASC cases encountered in Queen Mary Hospital, Hong Kong, China, from July 2000 to June 2004 (using TBS 1991 in the first 2-year period and TBS 2001 in the second) was analyzed. Among 4, 089 ASC cases studied, more than 50% had negative follow-up; this percentage was lower with TBS 2001. The percentage of ASC cases with a low-grade cervical intraepithelial neoplasia (CIN) end point was higher with TBS 2001, especially after application of LBC. There was also a decreasing trend of having this low-grade CIN end point with advancing age. Most clinically significant outcomes occurred after 6 months and before 1 year post-ASC diagnosis. With TBS 2001, more than 50% of ASC, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) were associated with high-grade CIN on follow-up. TBS 2001 improves the positive predictive value of ASC for clinically significant lesions. Introduction of dichotomous subcategorization of ASC is relevant, with ASC-H associated with a much higher risk of subsequent high-grade squamous lesions.