321例宫颈细胞学不典型腺细胞癌临床分析

目的探讨宫颈细胞学不典型腺细胞（AGC）患者细胞学分类、病理分型与人乳头状瘤病毒（HPV）表达相关性及AGC患者的有效筛查。方法回顾性分析2008年10月至2009年10月于北京妇产医院接受宫颈细胞学检查并诊断包含AGC,且接受阴道镜检查、组织病理活检及HPV检测的患者321例,将病理结果、HPV表达情况同细胞学结果对比研究。结果 321例AGC患者中,AGC合并高度鳞状上皮内病变（HSIL）/可疑原位癌（CIS）组患病率83.3%（10/12）,经χ2检验明显高于单纯AGC组的21.6%（30/139）及AGC合并ASCUS/LSIL组的29.4%（50/170）,χ2=21.215,P〈0.05。倾向瘤变的宫颈不典型腺细胞（AGC-FN）组及AGC可疑腺癌组患病率分别为48.6%（18/37）和50.0%（1/2）,经χ2检验明显高于不典型腺细胞（AGC-NOS）组的23.1%（65/282）,χ2=26.145,P〈0.05。HPV对于AGC患者阳性病变检出灵敏度为43.3%;特异度为79.8%;阳性预测值为37.1%;阴性预测值为83.7%。结论需高度关注AGC合并HSIL以上鳞状上皮诊断,或分型为AGC-FN及AGC可疑腺癌的细胞学报告。高危型HPV检测在评价AGC中具有重要价值。

The diagnostic value of atypical glandular cells with other conditions for adenocarcinoma in situ

Objective To analyze the relationship between adenocarcinoma in situ and positive atypical glandular cells（AGC）with other conditions.Methods A total of 1 326（3.4%）cases were confirmed with AGC in Beijing Obstetric and Gynecology Hospital between October 1,2008 and October 1,2009.Three hundred and twenty-one cases of the women with AGC were retrospectively investigated for the association of results from colposopy,biopsy and HPV testing.Results The prevalence rate of adenocarcinoma in situ was significantly higher in AGC positive women with HSIL/CIS（83.3%,10/12）than that in AGC positive only group（21.6%,30/139）or in group with AGC and ASC/LSIL（29.4%,50/170）（P0.05）.The cases with cytological type of AGC-FN or AGC.AIS had significantly higher prevalence rate of adenocarcinoma in situ（48.37%,18/37;50.0%,1/2 respectively）than that in those of AGC-NOS（23.1%,65/282）.The positive and negative predictive values of HPV testing were 37.1% and 83.7% respectively.Conclusion The high risk of adenocarcinoma in situ was associated with the cases of positive AGC and HSIL condition or the cytological type of AGC-FN and AGC-AIS.HPV testing has a good predictive value for the disease.