非典型腺细胞在子宫颈细胞学筛查中的临床意义

Clinical significance of atypical glandular cells in cervical cytology screening

目的通过分析宫颈细胞学筛查中非典型腺细胞(AGC)的组织学及高危型人乳头瘤病毒(HR-HPV)检测结果,探讨AGC诊断的临床价值及管理。方法对2014年2月—2018年8月宫颈细胞学筛查中报告为AGC的729例患者的宫颈、子宫内膜组织学及HR-HPV检测结果进行回顾性分析,以组织学宫颈高级别上皮内病变(HSIL)、子宫内膜非典型增生及以上病变作为阳性结果。结果AGC的检出率为0.4%(729/193330)。729例AGC患者中,有效随访681例,组织学HSIL及以上病变(HSIL+)154例(22.6%),其中HSIL 65例,宫颈鳞状细胞癌15例,宫颈腺癌19例,宫颈腺鳞癌2例,宫颈毛玻璃细胞癌1例,子宫内膜癌47例,子宫内膜非典型增生2例,子宫腺肉瘤1例,卵巢浆液性腺癌2例。年龄>40岁HSIL+检出率(25.91%,114/440)高于≤40岁(16.6%,40/241),两者比较,差异有统计学意义(P<0.01);年龄≤40岁组中HSIL+检出率明显高于子宫内膜病变,两者比较,差异有统计学意义(P<0.01);年龄>40岁组中严重宫颈病变的检出率与子宫内膜病变的检出率相近(P>0.05)。729例AGC患者中有HR-HPV检测结果者501例,其中HR-HPV阳性173例(34.5%)。在154例HSIL+患者中,HR-HPV阳性78例(50.6%),其中宫颈上皮内病变HR-HPV阳性率明显高于子宫内膜病变,两者比较,差异有统计学意义(P<0.001)。结论AGC的检出率低,但与多种癌及癌前病变密切相关,≤40岁患者以宫颈病变为主,>40岁患者宫颈病变与子宫内膜病变检出率相近。AGC联合HR-HPV检测对临床诊疗有非常重要的提示作用。

Objective To explore the clinical application value and management of AGC diagnosis by analyzing the histology and HR-HPV test results of cervical cytology screening for atypical glandular cells(AGC).Methods The cervical and endometrial histological results and HR-HPV test results of 729 AGC patients from February 2014 to August 2018 were retrospectively analyzed.The positive results of epithelial atypical hyperplasia and above were classified according to the histological examination results.Results The detection rate of AGC was 0.4%(729/193330).A total of 681 cases were effectively followed up in the 729 cases of AGC,and 154 cases were HSIL+(22.6%).Among them,HSIL was 65 cases,15 cases of cervical squamous cell carcinoma,19 cases of cervical adenocarcinoma,2 cases of cervical adenosquamous cell carcinoma,1 case of cervical ground-glass cell carcinoma,47 cases of endometrial carcinoma,2 cases of endometrial dysplasia,1 case of uterine adenosarcoma and 2 cases of ovarian serous adenocarcinoma.The detection HSIL+rate of age>40 years old(25.91%,114/440)was higher than age≤40 years old(16.6%,40/241),and the difference was statistically significant(P<0.01).The detection rate of HSIL+in the age≤40 years old group was significantly higher than that of endometrial lesions,and the difference was statistically significant(P<0.01).The detection rate of severe cervical lesions was similar to that of endometrial lesions in the age>40 years old group(P>0.05).Among 729 cases of AGC,patients with HR-HPV test results was 501 cases,HR-HPV positive was 173(34.5%).In HSIL+154 cases,HR-HPV positive was 78(50.6%).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 of cancers and precancerous lesions.Cervical lesions were mainly found in patients aged≤40 years old.The detection rate of cervical lesion was similar to that of endometrial lesion in patients aged>40 years old.AGC combined with HR-HPV can play a very important role in clinical diagnosis and treatment.